{
  "abstract": "Introduction The capsule-sponge trefoil factor 3 (CS-TFF3) test is a minimally invasive screening test for Barrett’s oesophagus (BO), the safety and performance of which has been tested across seven multicentre studies. As patients with both a CS-TFF3 test result and endoscopic follow-up are limited in each study, we performed the first pooled analysis in screening populations to accurately estimate the test’s performance for detecting BO.Methods Data from seven studies: BEST1 (Kadri, 2010, PMID: 20833740), BEST2 (Ross-Innes, 2015, PMID: 25634542), BEST3 (Fitzgerald, 2020, PMID: 32738955), CYTOPRIME2 (Rosa, 2025, DOI: 10.1136/flgastro-2025-103257), DELTA, NHSE (Gourgiotis, 2025, PMID: 39794909), and NHSS (Chien, 2024, PMID: 39592951), were used. Patients with reflux symptoms and no prior BO diagnosis, who swallowed a capsule sponge, were selected. Patients were further grouped based on participation in a study enriched for a high-risk population or a study looking at a routine reflux referral cohort. High-risk populations were determined by age ≥50 and persistent reflux symptoms, or patients with known risk factors such as male sex, high body mass index and family history of BO or oesophageal adenocarcinoma. A sub-analysis of BEST1 and BEST2 patients (n=1653), all of whom received endoscopic follow-up regardless of CS-TFF3 test results, estimated the test’s sensitivity and specificity. For all estimates, results from the first complete swallow (i.e. including retrieval of gastric columnar cells) were used, and no results beyond the first repeat procedure were included.Results In six cohorts, 7,573 participants were eligible for analysis, of which 13.1% (990/7573) had a successful sponge which tested positive for either TFF3 or cellular atypia, and 91.2% (908/990) received a follow-up endoscopy. The overall positive predictive value (PPV) for detecting BO was 38.5% (350/908 95% CI: 35.4-41.8). The PPVs for high-risk enriched and routine referral populations were 47.5 (271/570 95% CI: 43.4-51.7) and 23.4 (79/338 95% CI: 21.8-33.1), respectively ( figure 1). In studies with endoscopic follow-up for all patients the CS-TFF3 test achieved a sensitivity of 93.5% (505/540 95% CI: 91.0-95.4) and specificity of 91.7% (716/781 95% CI: 89.5-93.5).Conclusions With increased power from the pooled analysis, test performance estimates were obtained with narrow confidence intervals. They are comparable to the faecal immunohistochemistry test which has been recommended as the primary test for bowel cancer screening. Furthermore, the CS-TFF3 test demonstrated significantly higher PPV when performed on a high-risk population (χ 2: p<1e-5), demonstrating the necessity of enrichment in a screening setting.Abstract FP33 Figure 1Positive predictive values for individual studies and pooled by high-risk or routine reflux referral cohorts",
  "authors": [
    {
      "affiliations": [
        "Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, United Kingdom"
      ],
      "name": "Tim Somerset"
    },
    {
      "affiliations": [
        "Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, United Kingdom"
      ],
      "name": "Caryn Ross-Innes"
    },
    {
      "affiliations": [
        "Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, United Kingdom",
        "Department of Gastroenterology, Addenbrookes Hospital, Cambridge University NHS Foundation Trust, Cambridge, United Kingdom"
      ],
      "name": "Andreas Hadjinicolaou"
    },
    {
      "affiliations": [
        "Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, United Kingdom",
        "Department of Gastroenterology, Addenbrookes Hospital, Cambridge University NHS Foundation Trust, Cambridge, United Kingdom"
      ],
      "name": "Rebecca Fitzgerald"
    }
  ],
  "title": "FP33 Robust performance estimates of capsule-sponge-trefoil factor 3 test for detecting barrett’s oesophagus: a pooled analysis of multicentre studies",
  "uid": "ed8f4d85-5fc2-5822-815d-02815c804a0c"
}