Capsule sponge devices
Topic Status Complete
Capsule sponge devices to detect Barrett’s oesophagus and early-stage oesophageal cancer
Outcome of the appraisal
The evidence supports the routine adoption of capsule sponge devices with relevant biomarker testing (TFF3, p53, cellular atypia) within the diagnostic pathway for Barrett’s oesophagus in people with chronic reflux.
Capsule sponge testing demonstrates good diagnostic accuracy for the detection of Barrett’s oesophagus. Adding capsule sponge testing to the diagnostic pathway for Barrett’s oesophagus in people with chronic reflux, whilst slightly reducing the benefit to patients, was estimated to be cost-effective.
The evidence is insufficient to support routine adoption of capsule sponge testing for Barrett’s oesophagus surveillance due to a lack of clinical outcomes to determine cost effectiveness. HTW recommends further evidence generation on the impact of capsule sponge testing on time to diagnosis and treatment, long term clinical outcomes, and longitudinal diagnostic accuracy in those undergoing surveillance.
Why was this topic appraised?
Patients with chronic reflux or gastro-oesophageal reflux disease (GORD) can develop the precancerous condition Barrett’s oesophagus, which may then progress to oesophageal cancer. The prognosis of oesophageal cancer is poor as the early stages may be asymptomatic and patients often do not present until it is advanced. Patients with GORD may be offered upper gastrointestinal tract endoscopy to check for Barrett’s oesophagus or signs of cancer and those with confirmed Barrett’s oesophagus are recommended to receive regular endoscopic surveillance. However, the majority of people undergoing endoscopy will be found not to have these conditions and the current wait times for endoscopy in Wales are very long, with significant pressure on the service.
Capsule sponge testing can be used as a triage and risk stratification test to determine whether endoscopy is required, how urgently, and how frequently for surveillance. The use of capsule sponge testing could therefore lead to reduced pressure on endoscopy services by only referring, and then prioritising, those that show biomarkers of Barrett’s oesophagus or malignancy.
This topic was suggested to HTW by the Clinical Lead for the National Cancer Recovery Programme.
Plain language summary
What is Barrett’s Oesophagus?
Barrett’s oesophagus is a condition in which the cells of a person’s throat (oesophagus,) begin to change. Usually, these cells are flat cells. In Barrett’s oesophagus, these cells become more column-shaped.
Over time, these changes can happen to more and more of the cells in the throat. This increases the risk that they could develop into a cancer.
People with Barrett’s oesophagus usually don’t have symptoms. People who have a history of acid reflux and having extra weight around the waist are more likely to get Barrett’s oesophagus.
How is Barrett’s oesophagus usually detected?
Barrett’s oesophagus is usually found using endoscopy. The endoscopy process involves a long tube with a camera at the end that is passed down the throat to look at the cells. If changing cells can be identified early, then it may help to prevent them from progressing into cancer. However, an endoscopy is an invasive and uncomfortable procedure with long waiting lists.
What are capsule sponge devices?
Capsule sponge devices are small capsules like tablets that can be swallowed. They are attached to a string. Once swallowed, the capsule dissolves and a sponge from inside is released and expands. The string is then pulled to bring the sponge back up through the throat, collecting cells on the way. The cells are then sent to a lab to see if they are changing shape.
What did Health Technology Wales do?
HTW looked for evidence on the use of capsule sponge devices. The evidence supports the routine adoption of capsule sponge devices with relevant biomarker testing (TFF3, p53, cellular atypia) within the diagnostic pathway for Barrett’s oesophagus in people with chronic reflux. The evidence is insufficient to support routine adoption of capsule sponge testing for Barrett’s oesophagus surveillance due to a lack of clinical outcomes to determine cost effectiveness.
Guidance
GUI069 10.2025
Evidence Appraisal Report
EAR069 10.2025
Topic Exploration Report
TER568 10.2024 (superseded by EAR069 10.2025)
Health Technology Wales Partners
