Submitted by Catherine Atkins on Thu, 13/08/2026 - 15:31
Congratulations to Caryn Ross-Innes, Tim Somerset, Rebecca Fitzgerald, and colleagues at the Early Cancer Institute on their latest publication in Gastroenterology1 — a long-term follow-up analysis of the BEST3 trial that examined the clinical credibility of the capsule sponge as a screening tool 2
Barrett's Oesophagus is a precursor condition to oesophageal adenocarcinoma, typically arising from chronic gastroesophageal reflux. Early detection has been shown to make a great difference to outcomes, but endoscopy — the conventional diagnostic route — is invasive and impractical as a first-line test for the large population presenting with reflux symptoms.
The capsule sponge, developed in the Fitzgerald lab, offers a minimally invasive alternative: an ingestible capsule that dissolves to release a small mesh sponge, retrieved via a string to sample oesophageal cells which are then tested for the biomarker TFF3. The approach is inexpensive, well tolerated, and practical to use in primary care.
The original BEST3 trial, involving more than 13,600 people with recurrent reflux symptoms, showed that the capsule sponge pathway increased the detection of Barrett’s oesophagus 10-fold compared with usual care, while also enabling the detection of treatable precancerous changes and early cancer.
This latest study asked an equally important question: how reliable is a negative test?
Drawing on registry-linked data (94% complete) for over 1,600 BEST3 participants, with a median follow-up approaching seven years, the authors report no missed oesophageal cancers among those who tested negative. We also looked to see whether there were any gastric cancers as, although the capsule sponge is not designed to test for this, it is a consideration for who to refer for a capsule sponge versus an endoscopy. There was one gastric cancer diagnosed 5 years after the sponge test. The negative predictive value is 99.9% taking the gastric cancer into account.
The findings add to the evidence supporting minimally invasive approaches to detecting Barrett’s oesophagus and identifying cancer at an earlier, more treatable stage.
This test is being used by GPs and community clinics in the NHS for patients presenting with heartburn. The next step is already underway. The BEST4 trial is investigating whether population-based screening of people at higher risk (older age and heartburn history) could reduce illness and deaths from oesophageal cancer.
1. Caryn S. Ross-Innes, Timothy Somerset, Andreas V. Hadjinicolaou, Anne Babbage, Adam Freeman, Rebecca C. Fitzgerald
Long-term follow-up from the Barrett’s Esophagus screening trial 3 demonstrates high negative predictive value of capsule sponge–trefoil factor 3 Test for esophageal adenocarcinoma
Gastroenterology, 2026,
https://doi.org/10.1053/j.gastro.2026.06.021.
2. Fitzgerald R, di Pietro M, O'Donovan M et al.
Cytosponge-trefoil factor 3 versus usual care to identify Barrett's oesophagus in a primary care setting: a multicentre, pragmatic, randomised controlled trial
The Lancet, 396, 333-344
https://doi.org/10.1016/S0140-6736(20)31099-0