Minimally invasive esophageal sponge cytology sampling is feasible in a Tanzanian community setting

Esophageal sponge cytology is an endoscopy alternative well accepted by patients with extensive data for accuracy in the context of adenocarcinoma. Few studies have assessed its feasibility in asymptomatic community members, and fewer still in East Africa, where esophageal squamous cell carcinoma (ESCC) rates are high. We aimed to assess the feasibility of a capsule‐based diagnosis of esophageal squamous dysplasia (ESD), an ESCC precursor, which may benefit epidemiological and early detection research. We collected Cytosponge collections in 102 asymptomatic adults from Kilimanjaro, Tanzania. Uptake, acceptability and safety were assessed. Participants scored acceptability immediately following the procedure and 7 days later on a scale of 0 (least) to 10 (most acceptable). Slides from paraffin‐embedded cell clots were read by two pathologists for ESD and other pathologies. All participants (52 men, 50 women, aged 30‐77) swallowed the device at first attempt, 100 (98%) of which gave slides of adequate cellularity. Acceptability scores were 10 (53%), 9 (24%), 8 (21%), 7 (2%) and 6 (1%), with no differences by age, sex or time of asking. Cytological findings were esophageal inflammation (4%), atypical squamous cells of uncertain significance (1%), low‐grade dysplasia (1%), gastritis (22%) and suspected intestinal metaplasia (6%). Setting‐specific logistical and ethical considerations of study implementation are discussed. We demonstrate the safety, acceptability and feasibility of Cytosponge sampling in this setting, paving the way for innovative etiology and early‐detection research. Targeted sampling strategies and biomarker development will underpin the success of such initiatives. The study protocol is registered on ClinicalTrials.gov (NCT04090554). What's new? Endoscopy is often the standard method for diagnosing esophageal squamous cell carcinoma (ESCC). However, in resource‐limited regions, lower‐cost alternatives are urgently needed, especially for early‐detection screening programs. Esophageal sponge cytology is one such alternative, but would it be useful for large‐scale screening? In this preliminary study, the authors tested this “pill‐on‐a‐string” approach in a region of Tanzania with high ESCC incidence. They found that the method is acceptable, safe, and feasible for screening asymptomatic community members in a high‐risk region. These results will aid in the design of novel aetiology, biomarker, and early‐detection research studies.