Initial multicenter experience with nitrous oxide cryoballoon for treatment of flat duodenal adenomas (with video)

Endoscopic balloon cryoablation plus transurethral resection for bladder cancer: A phase 2, multicenter, randomized, controlled trial

“…In terms of intraluminal tumors, endoscopic cryoablation has been introduced in recent years 7 . Only a few clinical trials have reported application of endoscopic cryoablation for precancerous gastrointestinal lesions and neoplasms, most of which were single‐arm or retrospective studies 8–11 . The inspiration for endoscopic balloon cryoablation (EBCA) was derived from the FIRE AND ICE study, which compared cryoballoon with radiofrequency ablation in paroxysmal atrial fibrillation 12 .…”

“…7 Only a few clinical trials have reported application of endoscopic cryoablation for precancerous gastrointestinal lesions and neoplasms, most of which were single-arm or retrospective studies. [8][9][10][11] The inspiration for endoscopic balloon cryoablation (EBCA) was derived from the FIRE AND ICE study, which compared cryoballoon with radiofrequency ablation in paroxysmal atrial fibrillation. 12 One recent study demonstrated the efficacy and safety of a nitrous oxide cryoballoon in eradicating Barrett esophagus.…”

Cryoballoon ablation for duodenal adenomas: Time to warm up to a cool new approach?

“…In summary, Dbouk et al 10 present CBA, a novel and, dare we say, "cool" potential addition to our standard toolkit to manage duodenal adenomas. Clearly, there is more work to be done, but the upside may be significant, particularly if the rates of adverse events associated with managing these lesions can be lowered while maintaining an efficacy and durability comparable with those of endoscopic resection.…”

“…Finally, no patient was noted to have an increase in polyp size or evident progression to cancer. 10 Some of the limitations of this study are inherent in its retrospective multicenter nature and the novelty of the technique. The size of the polyps selected for treatment, prior interventions, cryoablation dosimetry, the median number of ablations per procedure, duration between endoscopies, and follow-up period (ranging from 3 to 12 months) were not standardized.…”

“…Nevertheless, we are often asked about, and usually accept, these risks because the alternative to endoscopic resection may also be major surgery, such as pancreaticoduodenectomy, which itself can carry a perioperative morbidity of 30% to 60% and mortality of 4% to 5%. 5,9 Any alternatives to managing these difficult lesions are therefore welcomed, and one such novel approach is described in this issue in an article by Dbouk et al 10 They present retrospective data from 5 centers in the United States that used a nitrous oxide cryoballoon ablation system (CBA) to treat 17 flat or slightly elevated duodenal adenomas in 13 patients. Twelve patients each had a single sporadic adenoma, and 1 patient with familial adenomatous polyposis had 5 adenomas.…”