“Pill-on-a-Thread” Could Replace Endoscopy for Many Esophageal Cancer Patients

Patients with Barrett’s esophagus are currently monitored for signs of cancer through regular endoscopy, an invasive procedure in which a camera is passed down the esophagus into the stomach, which they may have to undergo 10 or more times in their lifetime. In the new test, patients swallow a pill on a thread, with the pill dissolving to reveal a sponge that collects esophageal cells as the thread is retrieved.

In this study, over 900 patients with Barrett’s esophagus from 13 hospitals across the UK underwent both capsule sponge and endoscopy tests, to determine the reliability of the capsule sponge to assess cancer risk in patients. Based on the result of the capsule test, patients were assigned to one of three risk categories (high, moderate, or low), and the results were compared with their endoscopy results. In 54% of patients, the capsule sponge test result was low risk. The capsule sponge successfully identified patients with potential early signs of cancer, allowing prioritisation of these patients for a confirmatory endoscopy and treatment. As only 0.4% of these patients were found to be at higher risk from an endoscopy, the authors conclude that the capsule sponge could be used to monitor patients with low-risk Barrett’s esophagus, instead of regular endoscopies.  

Co-author Professor Peter Sasieni from the Cancer Research UK Cancer Prevention Trials Unit at the Wolfson Institute of Population Health said: “Our findings suggest that the capsule sponge could help stratify patients with Barrett’s esophagus by risk and that half of them will fall into the low-risk group. Given that the risk of these individuals progressing to dysplasia and then to esophageal cancer is so low, it should be safe to replace their annual endoscopy with the capsule sponge.”

Professor Rebecca Fitzgerald, Lead author and Director of the Early Cancer Institute at the University of Cambridge said: “We are very excited by these results, which could lead to a test that is much more accessible and less operator dependent to improve standards for monitoring for patients with Barrett’s across the NHS and beyond.”

Chief Executive of Cancer Research UK, Michelle Mitchell, said: “If adopted widely, this innovative approach could spare significant numbers of people from discomfort and invasive endoscopies. By bringing this more accessible alternative into community care, we have the potential to save more lives.”

The study was supported by Cancer Research UK, Innovate UK, NHS England Cancer Alliance, and Medical Research Council, with infrastructure support from the National Institute for Health and Care Research Cambridge Biomedical Research Centre and the Experimental Cancer Medicine Centre.

Reference: Tan WK, Ross-Innes CS, Somerset T, et al. Biomarker risk stratification with capsule sponge in the surveillance of Barrett’s oesophagus: prospective evaluation of UK real-world implementation. The Lancet. 2025. doi: 10.1016/S0140-6736(25)01021-9

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