
The Cytosponge can be used to detect oesophageal cancer earlier.
Around 9,100 people are diagnosed with oesophageal cancer each year in the UK.
A big challenge with this type of cancer is that many people don’t realise there’s a problem until they start to have trouble swallowing. Often, these symptoms aren’t recognisable until a later stage in the disease.
But there may be an opportunity to detect the disease earlier. Some people develop a condition – called Barrett’s oesophagus – prior to developing into cancer.
Barrett’s oesophagus is much more common than oesophageal cancer, and although it will only become cancer in a handful of cases, it presents an opportunity for doctors to spot a problem early and intervene before cancer develops. But the typical test for Barrett’s oesophagus, endoscopy, is both invasive and expensive.
Enter the Cytosponge.
Cytosponge-TFF3 test is a ‘sponge on a string’ device coupled with a laboratory test called TFF3 developed by scientists funded by the Medical Research Council (MRC) and Cancer Research UK – a simple, quick and affordable test for Barrett’s oesophagus that can be done in a GP surgery.
And the latest results, published in The Lancet, suggest this Cytosponge-TFF3 test can identify ten times more people with Barrett’s oesophagus than current GP care.
We caught up with Professor Rebecca Fitzgerald, based at the University of Cambridge, whose team studies oesophageal cancer and has worked hard over the last decade to develop this innovative test.
How does it work?
Cytosponge is a small coated pill on a string that contains the sponge. It’s easy for people to swallow, and when the pill reaches the stomach, the coating dissolves and the sponge expands.
When the sponge is pulled back up, it collects some of the cells lining the oesophagus on its way. The sponge is sent off for analysis in the lab, “where we have developed a simple antibody test called TFF3 so that pathologists can easily spot the signs precancerous condition”.
Planting the seeds
A seed was planted for the idea for the Cytosponge in around 2000, whilst Fitzgerald was still in London.
“I was talking with my boss, Professor Mike Farthing, about how an endoscopy isn’t ideal for patients and for sampling, and how what you really need is some kind of bottle brush for easy collection of cells.”
But it was when Fitzgerald moved her research to Cambridge in 2002 that she began a prototype for this ‘bottle-brush’ idea. Over the years, the prototype evolved into what’s now recognised as the Cytosponge, which has been tested on thousands of people across the country.
The first real test for Cytosponge was to see if people were willing to try the sponge-on-a-string, and whether the process was feasible in a GP surgery.
And once that hurdle was cleared, it was time to test the accuracy of Cytosponge in clinical trials.
The latest results
The latest Cytosponge trial compared Cytosponge to the current model for managing people with heartburn symptoms, the main risk factor for Barrett’s and cancer of the oesophagus.
“What GPs ordinarily do if you’ve got reflux symptoms is to give you medication to get rid of the heartburn. So, most patients that see their GP with heartburn won’t get an endoscopy test,” Fitzgerald explains.
“Because the Cytosponge is such a simple test that you can do, basically in 10 minutes in a GP surgery, we wanted to compare what GP’s ordinarily do, with offering all patients who usually receive medication for heartburn the Cytosponge test.”
13,000 patients were enrolled in the study from GP surgeries across England. Half of these patients were offered the standard clinical care, while the other half were offered the Cytosponge.
At the end of the trial, the team analysed how many cases of Barrett’s oesophagus were picked up in each of the two arms of the trial, and the results were quite remarkable.
“We found 10 times more cases of Barrett’s oesophagus in the people that were offered a Cytosponge compared with what GP’s ordinarily do,” says Fitzgerald.
What’s more, the trial picked up a number of early stage cancers too.
“If the cancer is detected early you can cure the disease. You can remove it completely at endoscopy and the patient may not need to have chemotherapy and surgery to remove the oesophagus,” Fitzgerald explains.
The results will not only change the way Barrett’s oesophagus and oesophageal cancer is detected in the future, the success of the BEST3 trial has meant that cancers have been successfully detected and treated in those who took part.
Liz is one of those cases.
Liz’s story

Liz took part in the BEST3 trial in 2017.
Liz had suffered with acid reflux for many years. When she received a letter from her GP about the BEST3 trial, she signed up out of pure curiosity.
“I was curious about the trial because I’d never heard of Barrett’s oesophagus and so I just took part out of interest,” Liz explains.
A fortnight after having the Cytosponge test at her local GP surgery, Liz received a letter saying that the test indicated she did have Barrett’s oesophagus. Next, Liz required an endoscopy to clarify the results.
“I went and had an endoscopy and even I could see that things were not very good in my oesophagus. It was extremely inflamed and bleeding and not healthy looking at all.”
The endoscopy also revealed that she had early stage oesophageal cancer, “that was the moment when you suddenly think, oh, this is bad”.
Thankfully, the cancer had been caught early by the Cytosponge. “I didn’t have to have any harmful treatments at all. They could remove it by doing an endoscopic resection,” says Liz.
Liz is a retired scientist, who has experience of working in research labs. “I understood about a lot of the processes,” she explains, “there’s a huge amount of science behind it, but the procedure itself is so simple. It is, to my mind, a perfect test that could easily be carried out widely in the community.”
This was in 2017, at the beginning of the BEST3 trial. Since then, Liz has been busy enjoying life to the full. “Last year, as well as enjoying a 90-mile walk along the Ridgeway, I was able to put my hobby of pottery to good use by making a hundred coasters bearing an image of the Cytosponge. These were sent as a small thank you gift to the research nurses involved in the BEST3 trial.”
A COVID-response Cytosponge clinic
The team recently received a grant to begin implementing the Cytosponge test, both in GPs and in secondary care across England in the coming years.
But the onset of the coronavirus pandemic meant that plans were quickly adjusted.
“COVID-19 means that endoscopy services were pretty much shut down,” Fitzgerald explains, “it means that there are people out there who just weren’t being referred, or who had been referred and were being stalled and not getting access to diagnostic tests.”
The team received permission to begin procedures immediately, setting up a ‘COVID Cytosponge clinic’ at the Addenbrooke’s hospital in Cambridge.
“We were taking patients referred by the two week wait from their GP,” says Fitzgerald. “These are people who can still swallow capsules, who don’t sound quite so poorly, but otherwise would have had a delay in getting the endoscopy, who got the Cytosponge test.”
This is a different way of using Cytosponge than had been tested in the previous trials, but analysing the data collected in this Addenbrooke’s pilot will help to find out if Cytosponge can play a useful role in working out who would benefit from an endoscopy the soonest.
The Cytosponge test has reaffirmed the need to continue searching for innovative diagnostic tools, that detect pre-cancerous conditions quickly and non-invasively. One that can help save lives in today’s uncertain circumstances and into the future.
5 October 2020 update: Cytosponge is being introduced in Scotland as a ‘simpler alternative to endoscopy’ in a £500,000 programme. NHS Greater Glasgow and Clyde and NHS Lanarkshire will be the first to implement the test, with training planned for Fife, Borders, Forth Valley and Lothian later this month.
15 December 2020 update: The National Institute for Health and Care Excellence have developed a Medtech innovation briefing on ‘Cytosponge for detecting abnormal cells in the oesophagus’. The briefing aims to support NHS commissioners and staff who are considering implementation of Cytosponge into services. You can read the full briefing, here.
8 July 2021 update: Scotland has announced that the Cytosponge device will now be used across all mainland Scottish health boards in the surveillance of people with Barrett’s Oesophagus. This reflects challenges in securing timely endoscopy for patients but also the interest in exploring the different ways in which Cytosponge could be used to shift patient care and outcomes. We’ll continue to monitor research and evaluation in this area with keen interest.
Lilly
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Reference
Fitzgerald RC, et al. (2020). ‘A pragmatic randomised, controlled trial of an offer of Cytosponge-TFF3 test compared with usual care to identify Barrett’s oesophagus in primary care.’ The Lancet. DOI: https://doi.org/10.1016/S0140-6736(20)31099-0
Comments
Maria Parkes August 16, 2020
Amazing idea to detect esophageal cancer
Well done
pat kwing August 16, 2020
It is wonderful and uplifting to hear and read about these results and the hard work that has led to these discoveries.
Victoria Watt August 16, 2020
The test is brilliant ,in it’s simplicity , and ease of use , more people will get tested because of this ; and get their treatment earlier and hopefully survive to tell their tale .
Well Done !
Janet Brandon-King [Mrs] August 16, 2020
I have been on bi-annual endoscopy tests for about 10 years. Is it possible to switch to the cytosponge system? It sounds so much better all round – less cost for the NHS and less invasive for the patient
Roy Brown August 16, 2020
I am very impressed to read of your above breakthrough.
I have a dear friend who suffers from acid reflux
and have passed this exciting article onto her.
Lois Gillard August 16, 2020
This is amazing news I would have benefited from this about 4 years ago as have recovered from cancer where they found it after I couldn’t swallow it would have possibly saved me from painful and traumatic treatment I am however extremely grateful to be here cancer free and that’s down to the fantastic team and their expertise
Michael Brady August 16, 2020
That’s a great opportunity for mankind and womankind, as my mother died of this,keep up the good work.
Dianne Docherty August 16, 2020
This has been very interesting to read, I know I have Barrets oesophageal and was wondering if this trial would benefit people like me? .
Vicky Sellars August 16, 2020
When will this test become widely available? I suffer really badly with GERD and my dad is recovering from Oesophageal cancer, hence my reason for asking.
Lilly Matson August 25, 2020
Dear Vicky,
Thank you for your question.
We don’t yet know exactly when the Cytosponge test will be routinely available at GP surgeries because more research still needs to be done, but we hope this will be as soon as possible. The test is currently being piloted around the country and researchers are measuring the costs and how effective it is. They estimate that it will be rolled out within 3 to 5 years.
Best wishes,
Lilly, Cancer Research UK
Christine StJean August 16, 2020
I think this is a brilliant idea that will save lives
Michelle Swift August 16, 2020
Can I get this done, I have had heartburn and other gastro probs for years, I live in Rotherham
JANET HICKS August 16, 2020
BRILLIANT IDEA.
Carol Smith August 16, 2020
This sponge technique is so amazing. I wish it had been available when my grandmother was alive. This may have detected her cancer and saved her life. Hope for the future!!
JUDITH KASOWE August 15, 2020
Thanks for the work you are doing
Ioana August 15, 2020
Would be a blessing for so many people and their family.Pls don’t stop,keep doing it because is worthy
Christine Clifton August 15, 2020
Absolutely brilliant loved to be able to read
Harry Smith August 15, 2020
I’ve had Barrett’s for years and have a endoscopy every 2yrs but this sounds an excellent step forward. how soon will it be in General practice?
Lilly Matson August 25, 2020
Dear Harry,
Although we don’t know exactly when the Cytosponge test will be routinely available at GP surgeries, as more research still needs to be done, we do hope this will be as soon as possible. Right now, the test is being piloted around the country and researchers are measuring the costs and how effective it is. They estimate that it will be made available within 3 to 5 years.
Best wishes,
Lilly, Cancer Research UK
Eileen Weston August 15, 2020
I wish my husband could have this test done he’s suffered with reflux for years and is prescribed emoprazole he’s always getting food stuck and has to make himself vomit to clear it . I worry all the time for him
Katherine Eno August 15, 2020
Really interesting research and great results.
Madonna Stewart August 15, 2020
Wow that’s incredible xx
Christine Colborne August 15, 2020
How can I get tested this way?
I have had herd and acid stomach symptoms for years and during lockdown my symptoms have returned big time. My surgery is running in Locums and it’s not easy to get an appointment.
I only mentioned to my husband this morning that I was concerned especially as I don’t have a big appetite these days and feel quite tired plus a cough and sore throat
Graham Wharton August 15, 2020
Really interesting and informative article, I do hope Cancer Research is able to get fully back on track soon, Your work is priceless
Margaret Rayner 15.8.20 August 15, 2020
I volunteered for the test after being asked to take part by my GP. I do have Reflux and benign polyps and was glad to take part .lts a simple test which is not unduly unpleasant
David Dennett August 15, 2020
Fantastic research & an article easy to understand. Sad to hear you have had to reduce staff & we would be prepared to increase our modest quarterly donation. Will be in touch Monday . Keep up good work.Kind regards
Jacqueline Newby August 16, 2020
I find this particularly interesting as my brother died of oesophageal cancer when he was 54 almost 20 years ago.