University Hospitals Sussex has recruited its first patients into a national clinical trial investigating a simple, less invasive method to improve early detection and monitoring of people at risk of oesophageal cancer.
The trial, known as BEST4, is exploring whether a ‘sponge on a string’ test could replace some of the routine endoscopies currently used to monitor patients with Barrett’s oesophagus (BO).
Barrett’s oesophagus is caused when the normal cells lining the oesophagus (food pipe) have been replaced with abnormal cells which can develop into oesophageal cancer.
Patients with Barrett’s oesophagus undergo regular endoscopies – where a long tube with a camera on the end is passed down the throat and into food pipe – to check for cell changes which could become cancerous. This is a specialised, invasive procedure, performed by a doctor, involving sedation and multiple biopsies if suspicious cells are found.
The trial will assess whether the ‘sponge on a string’ test, combined with a biomarker panel, offers a less invasive alternative for monitoring these patients for signs of cancer and deciding if an endoscopy is needed.
Nine patients with BO have been recruited through the endoscopy service at Royal Sussex County Hospital into the national trial. At UHSussex, it’s led by Principal Investigator and Consultant Gastroenterologist Dr Fergus Chedgy.
Valentina Toska, Senior Clinical Research Practitioner, who coordinates this study and carries out the procedure, explains: “This test is minimally invasive, takes less than 20 minutes, and is far more comfortable for patients – helping improve the patient experience. It can be done in a standard clinic room rather than an endoscopy suite, and with appropriate training, can be performed by doctors, nurses, and allied health professionals (AHPs).”
During the procedure, the patient swallows a small 3cm capsule attached to a string, with water. After around seven minutes, the capsule dissolves in the stomach and leaves a small sponge which expands to the size of a cherry tomato.
The sponge collects cells from the oesophagus lining as it is pulled out from the stomach by a clinician, which is sent for lab testing for signs of oesophageal cancer. Following the sponge test, patients undergo their routine endoscopy.
The findings from the sponge test and the endoscopy will be compared to help understand if the sponge test can detect cell changes and determine its potential to guide decisions about whether an endoscopy is necessary. If successful, this approach could mean fewer endoscopies and shortened waiting times, as those presenting with heartburn or acid reflux symptoms can have the test performed on the day by a trained professional.
Dr Don Edward Rangedara who is sub-investigator for this trial, said: “The BEST4 trial is an exciting opportunity to potentially transform how we monitor patients with Barrett’s oesophagus. Recruitment at our site has gone well thanks to a fantastic team effort, and it’s been hugely rewarding and inspiring to see patients so engaged with research that may shape future surveillance pathways. I’m very proud to contribute to this important national trial and look forward to the impact it could have on improving early detection and outcomes in oesophageal cancer.”
Around 1 person out of every 50 diagnosed with cancer in the UK has oesophageal cancer, with around 9,400 new cases each year (Cancer Research UK). Symptoms of this form of cancer often appear late, causing many cases to be diagnosed after the disease has already advanced, making it more difficult treat. As a result, it’s the UK’s 7th leading cause of cancer death (Cancer Research UK) – making early monitoring of high-risk patients critical.
Mel Smith, Lead Nurse for the Multi-Speciality Research Team and Paediatrics said: “Over the last four to five years, we have collaborated with Fergus and the endoscopy team at Royal Sussex County Hospital to run several studies.
“The endoscopy team is a prime example of how research is becoming embedded in everyday care, with the potential to improve treatment and outcomes for patients.”
The trial is funded by Cancer Research UK and the National Institute for Health and Care Research and aims to recruit 2,000 participants.
As part of the clinical trial, data will be collected over a three-year period and if successful could become part of the standard of care when monitoring people with BO, enhancing patient comfort, improving early detection, and potentially saving lives.