A novel capsule-sponge test combined with biomarker analysis has demonstrated significant potential for risk stratification in patients with Barrett esophagus, according to research published in The Lancet on June 23, 2025. The study, led by W. Keith Tan from Cambridge University, evaluated 910 adult patients with nondysplastic Barrett esophagus and successfully identified those at highest risk for developing dysplasia or cancer.
Study Design and Patient Population
The prospective study evaluated a prespecified risk stratification tool comprising a pan-esophageal cell collection device coupled with biomarkers. All participants had nondysplastic Barrett esophagus confirmed at their last endoscopy and underwent capsule-sponge testing before being classified into risk categories.
Of the 910 patients recruited, the risk stratification tool classified 54% as low risk, 31% as moderate risk, and 15% as high risk. This distribution provides a framework for tailored surveillance strategies based on individual patient risk profiles.
Clinical Performance and Biomarker Findings
The high-risk group demonstrated a positive predictive value of 37.7% for any dysplasia or worse, indicating that more than one-third of patients identified as high-risk actually developed concerning pathological changes. The most significant finding emerged in patients presenting both atypia and aberrant p53 biomarkers, who showed a relative risk of 135.8 for high-grade dysplasia or cancer compared to the low-risk group.
Conversely, the low-risk group showed remarkably low disease progression, with only 0.4% prevalence of high-grade dysplasia or cancer. The negative predictive value reached 97.8% for any dysplasia or cancer in this group, suggesting that low-risk patients could potentially undergo less intensive surveillance without compromising safety.
Digital Pathology Integration
The research team incorporated machine learning algorithms as part of a digital pathology workflow, which reduced the proportion of cases requiring p53 pathology review to 32% without missing any positive cases. This technological integration could streamline the diagnostic process and reduce laboratory workload while maintaining diagnostic accuracy.
Clinical Implementation Advantages
"The capsule sponge can be administered easily and quickly by nurses with only limited training required and will not need to take up precious endoscopy resources," Tan stated. This accessibility represents a significant advantage over traditional endoscopic surveillance, particularly in healthcare systems with limited endoscopy capacity.
The test's ease of administration could facilitate broader screening programs and more frequent monitoring of Barrett esophagus patients without straining endoscopy resources. This approach may be particularly valuable for patients in remote areas or those with limited access to specialized gastroenterology services.
Technology Licensing and Development
Medtronic holds the license for the cytosponge technology, while several study authors disclosed ties to Cyted Health and Medtronic through patents related to the test. This commercial backing suggests potential for broader clinical implementation and continued technological development.
The combination of capsule-sponge technology with biomarker analysis represents a significant advancement in Barrett esophagus management, offering a less invasive alternative to repeated endoscopic surveillance while maintaining high diagnostic accuracy for identifying patients at risk of malignant progression.
