Effective surveillance of Barrett’s esophagus (BE) requires representative sampling of the metaplastic epithelium to enable early detection of dysplasia or adenocarcinoma. However, the current gold standard of forceps biopsies  is limited by sampling error, interobserver variability in histopathological assessment, and poor integration with emerging molecular diagnostic strategies. Although novel widefield sampling devices have shown promise for more extensive coverage of the BE segment, their clinical adoption is often restricted by patient intolerance or inadequate sampling. As a result, obtaining truly representative tissue samples remains technically challenging.

We use a transendoscopic sampling (TES) technique involving a dissolvable capsule sponge to enable comprehensive sampling during routine endoscopy. The capsule is introduced into the stomach alongside the endoscope using a biopsy forceps. Upon dissolution, it expands into a rough-textured sponge. While the endoscopist inspects and cleans the BE segment, the sponge is deployed and subsequently retrieved transorally, collecting cells from the entire BE without cross-contamination. The procedure results in visible abrasions across the entire BE segment, including targeted suspicious lesions.

In a prospective series of 226 TES procedures, technical success was achieved in 224/226 cases (99.1%). 2/226 procedures failed due to severe esophageal stenosis that prevented passage of the capsule sponge. All 64 BE patients with histologically confirmed progression (high-grade dysplasia or esophageal adenocarcinoma) or endoscopically suspicious lesions underwent successful sampling. In 100% of the successfully retrieved samples (224/224), sufficient material was collected for DNA isolation.

Transendoscopic sampling using the capsule sponge is a safe, well-tolerated, and technically feasible procedure for widefield sampling of BE. It offers a scalable platform for integrating molecular biomarkers into routine surveillance and has the potential to complement, or even revolutionize, endoscopic surveillance in Barrett’s esophagus.