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‘Pill on a string’ test to transform oesophageal cancer diagnosis

‘Pill on a string’ test to transform oesophageal cancer diagnosis

A ‘pill on a string’ test can identify ten times more people with possible early signs of oesophageal cancer, NIHR-supported research has found.

The results from the BEST3 trial, which recruited participants across the Wessex region, have been published in The Lancet

They show that a new test can diagnose more cases of Barrett’s oesophagus, a condition that can lead to oesophageal cancer in a small number of people. The condition is usually diagnosed in hospital by endoscopy following a GP referral for long standing heartburn symptoms.

The Cytosponge test, developed by researchers at the University of Cambridge, is a small pill attached to a thread. The pill expands into a small sponge when it reaches the stomach after being swallowed by a patient. This is quickly pulled back up the throat by a nurse, collecting cells from the oesophagus for analysis.

Over 13,000 participants took part in the BEST3 trial and were randomly allocated to receive the sponge test or standard care.

Over the course of a year, the odds of detecting Barrett’s were ten times higher in those offered the Cytosponge, with 140 cases diagnosed compared to 13 in usual care.

In addition, the Cytosponge diagnosed five cases of early cancer (stage 1 and 2), whereas only one case of early cancer was detected in the GP group.

The Cytosponge test, which can be performed in a GP surgery and was well tolerated by patients, will help doctors to identify who needs an endoscopy.

Alongside better detection, the test also means cancer patients can benefit from less severe treatment options, if their cancer is caught at a much earlier stage.

Professor Rebecca Fitzgerald, from the Medical Research Council Cancer Unit at the University of Cambridge, who led the research, said:

“It’s taken almost a decade of research and testing thousands of patients to show that we’ve developed a better route to diagnosing Barrett’s oesophagus, and the sponge could also be a game-changer in how we diagnose and ensure more people survive oesophageal cancer.

“Compared with endoscopies performed in hospital, the Cytosponge causes minimal discomfort and is a quick, simple test that can be done by a GP. Our test is already being piloted around the country, so we hope more people across the UK could benefit from it.”

The researchers are currently putting the Cytosponge test through an economic evaluation and hope that it will be rolled out within GP practices within three to five years.

The trial, which is funded by Cancer Research UK, is jointly sponsored by Cambridge University Hospitals NHS Foundation Trust and University of Cambridge. Please visit for more information.