Focal cryoballoon versus radiofrequency ablation of dysplastic Barrett’s esophagus: impact on treatment response and postprocedural pain

Munster, Sanne N. van; Overwater, Anouk; Haidry, Rehan; Bisschops, Raf; Bergman, Jacques; Weusten, Bas L.

doi:10.1016/j.gie.2018.06.015

Cited by 48 publications

(44 citation statements)

References 34 publications

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“…Our data are in line with previously published series (CR-D achieved in 75 %-88 % of patients) [17,23,40]. A recent meta-analysis by Visrodia et al analyzed 11 studies with 148 patients with BE treated with cryotherapy for persistent dysplasia or IM after RFA.…”

Section: Nosupporting

confidence: 91%

“…We were also able to demonstrate durability of disease reversal with 72 % of patients (13/18) with BE neoplasia maintaining CR-D and 33 % of patients (6/18) maintaining CR-IM after a median follow-up of 19 months (IQR [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28].…”

Section: Nomentioning

confidence: 68%

“…There are no significant published data showing how deep cryoablation can reach into the mucosa or submucosa. Several studies in BE neoplasia [23] and other fields of medicine have shown that cryoablation is less painful [47,48]. Pain perception was not formally assessed in this study, but previous studies have shown that the cooling process may have an anaesthetic effect [49] by reducing or blocking nerve conduction and, therefore, less postprocedural discomfort than that seen with RFA [47].…”

Section: Nomentioning

confidence: 90%

“…The technique may ablate deeper than RFA whilst preserving the extracellular matrix [19] and therefore may result into lower stricture rates and deeper tissue destruction [20]. In addition, recent studies have shown that cryoablation to be better tolerated by patients and to be less painful [21][22][23].…”

Section: E891mentioning

confidence: 99%

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Cryoballoon ablation for treatment of patients with refractory esophageal neoplasia after first line endoscopic eradication therapy

et al. 2020

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Abstract Background and study aims Cryoablation with the Cryoballoon device is a novel ablative therapy that uses cycles of freezing and thawing to induce cell death. This single-center prospective study evaluated the feasibility of the focal cryoablation device for the treatment of areas of refractory esophageal neoplasia in patients who had undergone first line endoscopic eradication therapy (EET). Complete remission of dysplasia (CR-D) and complete remission of intestinal metaplasia (CR-IM) at first follow-up endoscopy, durability of disease reversal, rates of stenosis and adverse events were studied. Patients and methods Eighteen cases were treated. At baseline, nine patients had low-grade dysplasia (LGD), six had high-grade dysplasia (HGD) and three had intramucosal carcinoma (IMC). Median length of dysplastic Barrett’s esophagus (BE) treated was 3 cm. The median number of ablations per patient was 11. Each selected area of visible dysplasia received 10 seconds of ablation. One session of cryoablation was performed per patient. Biopsies were performed at around 3 months post-ablation. Results CR-D was achieved in 78 % and CR-IM in 39 % of patients. There were no device malfunction or adverse events. Stenosis was noted in 11 % of cases. At a median follow up of 19-months, CR-D was maintained in 72 % of patients and CR-IM in 33 %. Conclusions Cryoablation appears to be a viable rescue strategy in patients with refractory neoplasia. It is well tolerated and successful in obtaining CR-D and CR-IM in patients with treatment-refractory BE. Further trials of dosimetry, efficacy and safety in treatment-naïve patients are underway.

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Section: Nosupporting

confidence: 91%

Section: Nomentioning

confidence: 68%

Section: Nomentioning

confidence: 90%

Section: E891mentioning

confidence: 99%

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Cryoballoon ablation for treatment of patients with refractory esophageal neoplasia after first line endoscopic eradication therapy

et al. 2020

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“…The postprocedure median pain score was 1 out of 10 on day 2, reflecting less postprocedural pain than RFA therapy. 9 There were no strictures or serious adverse events. Self-limited mucosal lacerations occurred in 5% of patients upon balloon inflation, and interestingly, 16% of patients experienced idiopathic self-limited fever without associated symptoms.…”

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confidence: 90%

The Ice Age reborn?

Fasanella

McGrath

2019

Gastrointestinal Endoscopy

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The efficacy of radiofrequency ablation versus cryoablation in the treatment of single hepatocellular carcinoma: A population‐based study

et al. 2021

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Background Radiofrequency ablation (RFA) is an effective treatment for single hepatocellular carcinoma (HCC), but it is difficult to use against tumors in some locations and often leads to incomplete ablation as a result of the heat‐sink effect. This study was conducted to evaluate the efficacy of cryoablation compared with that of RFA in the treatment of single HCC. Methods This retrospective study was conducted based on the Surveillance, Epidemiology, and End Results (SEER) database. From 2004 to 2015, patients aged 40 to 79 diagnosed with HCC were included in the study. A propensity score matching (PSM) model was used to reduce selection biases. Results Before PSM, the median overall survival (mOS) and median cancer‐specific survival (mCSS) in the RFA group were slightly longer than those in the cryoablation group (p > 0.05). In the subgroup analysis, the mOS and mCSS of patients with tumor sizes <3, 3–5, and >5 cm who received RFA treatment were longer than those of patients given cryoablation treatment, but there was no significant difference (p > 0.05). Similar results were presented in patients at American Joint Committee on Cancer (AJCC) stages I and II. After PSM, the mOS and mCSS were slightly better in the RFA group than the cryoablation group but without significant differences. Univariate and multivariate analysis showed that cryoablation treatment was not an unfavorable factor for OS and CSS before or after PSM (p > 0.05). In the multivariable competing risk model, non‐cancer‐specific death was taken as a competing factor and cryoablation was also not unfavorable for the survival of patients before and after PSM (p > 0.05). Conclusion Cryoablation is non‐inferior to RFA therapy for single HCC patients without lymph node invasion or distant metastasis.

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Focal cryoballoon versus radiofrequency ablation of dysplastic Barrett’s esophagus: impact on treatment response and postprocedural pain

Cited by 48 publications

References 34 publications

Cryoballoon ablation for treatment of patients with refractory esophageal neoplasia after first line endoscopic eradication therapy

Cryoballoon ablation for treatment of patients with refractory esophageal neoplasia after first line endoscopic eradication therapy

The Ice Age reborn?

The efficacy of radiofrequency ablation versus cryoablation in the treatment of single hepatocellular carcinoma: A population‐based study

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