Oesophageal cancer has some of the poorest treatment and survival outcomes of all cancers in the UK, with an overall 10-year survival rate of only 12 per cent.1 Often asymptomatic, it is frequently diagnosed only once the disease has already developed beyond the possibility of cure. Barrett’s oesophagus is associated with an approximately tenfold increase in the risk of oesophageal cancer compared with the general population, meaning these patients need regular monitoring.2 With NHS waiting lists for endoscopy services longer than ever, the British Society of Gastroenterology is set to release new guidelines for Barrett’s management, which are expected to include recommendations on the role of capsule sponge technologies, such as EndoSign®.
Managing waiting lists is a constant balancing act, and the relatively low rate of malignant progression to cancer in Barrett’s patients must also be considered. The vast majority of surveillance endoscopies do not identify high grade dysplasia or cancer, meaning that they consume significant resources with a very small chance of identifying high yield pathologies. However, with Barrett’s oesophagus cases rising and poor survival rates for oesophageal cancer, patients need an efficient and scalable diagnostic pathway that can identify those most at risk while ensuring timely access to endoscopy. This has prompted ongoing discussion as to whether surveillance can be delivered more efficiently, with better risk stratification.
A faster, more patient-friendly approach
EndoSign capsule sponge technology – often referred to as a ‘pill-on-a-string’ test – has emerged as an important risk stratification tool for Barrett’s surveillance, and is already used to support endoscopy services at over 70 sites in the UK. The patient swallows a small capsule containing a sponge attached to a thin thread, which dissolves in the stomach after a few minutes. The sponge is then gently withdrawn by pulling the thread, collecting cells from the entire length of the lining of the oesophagus as it passes upward. These cells are then analysed for biomarkers associated with Barrett’s oesophagus and dysplasia. The test can be performed in minutes by any trained healthcare professional, in any care setting, without sedation, and is well tolerated by patients.
A valuable role in Barrett’s surveillance
A landmark study found that 54 per cent of Barrett’s patients were classified as low risk,3 suggesting that they may be safely monitored solely with capsule sponge technology alone, helping to guide endoscopy more effectively. This would release capacity – allowing high risk groups to be prioritised – while reducing costs and improving patient satisfaction. Using capsule sponge testing for risk stratification has helped NHS Scotland to cut waiting times by four months,4 and detect five times as many significant pathologies compared with the standard care pathway,5 highlighting the valuable role the test can play in Barrett’s surveillance.
References
- Oxford Cancer. (2026). Oesophagogastric Cancer Centre of Excellence. https://www.cancer.ox.ac.uk/research/networks/OCCE. Accessed 30th of April 2026.
- Januszewicz W, Fitzgerald RC. Medicine (Abingdon). 2019;47(5):275-285. doi: 10.1016/j.mpmed.2019.02.005
- Tan WK, Askinyte V, et al. The Lancet. 2025;406(10500):271-282. doi: 10.1016/S0140-6736(25)01455-2
- Chien S, et al. National adoption of an esophageal cell collection device for Barrett's esophagus surveillance: impact on delay to investigation and pathological findings. Dis Esophagus. 2024 ;37(5):doae002. doi: 10.1093/dote/doae002
- Tse, et al. Impact of introduction of a cytosponge barrett’s oesophagus surveillance service on the endoscopic pathology pattern. Gut. 2023;72:A7-A8.
