Outcomes after liquid nitrogen spray cryotherapy in Barrett's esophagus–associated high-grade dysplasia and intramucosal adenocarcinoma: 5-year follow-up

Abstract

Background Liquid nitrogen spray cryotherapy (LNSCT) has been shown to be a safe, well-tolerated, and effective therapy for Barrett’s esophagus (BE)-associated high grade dysplasia (BE-HGD) and intramucosal adenocarcinoma (IMC). Long-term follow-up is lacking. Aims The authors’ aim was to assess the efficacy, durability, and rate of neoplastic progression after LNSCT in BE-HGD/IMC at 3 and 5 years. Methods In this single-center, retrospective study drawn from a prospective database, patients with BE-HGD/IMC of any length treated with LNSCT were followed with surveillance endoscopy with biopsy for 3 to 5 years. Patients with intramucosal adenocarcinoma completely removed by endoscopic resection were included. Outcome measures included complete eradication of HGD (CE-HGD), dysplasia (CE-D), and intestinal metaplasia (CE-IM), incidence rates (IR), durability of response, location of recurrent IM and dysplasia, and rate of disease progression. Results 50 and 40 patients were included in 3-year and 5-year analyses. Initial CE-HGD, CD-D, and CE-IM were achieved in 98%, 90%, and 60%, respectively. Overall CE-HGD, CE-D, and CE-IM at 3 years were 96% (48/50), 94% (47/50), and 82% (41/50), and at 5 years were 93% (37/40), 88% (35/40), and 75% (30/40). IRs of recurrent IM, dysplasia, and HGD/esophageal adenocarcinoma per person-year of follow-up after initial CE-IM were 12.2%, 4.0%, and 1.4% per person-year for the 5-year cohort. Most recurrences were found immediately below the neosquamocolumnar junction. Two of 7 HGD recurrences occurred later than 4 years after initial eradication, and 2 patients (4%) progressed to adenocarcinoma despite treatment. Conclusion In patients with BE-HGD/IMC, LNSCT is effective in eliminating dysplasia and intestinal metaplasia. Progression to adenocarcinoma was uncommon, and recurrence of dysplasia was successfully treated in most cases. Long-term surveillance is necessary to detect late recurrence of dysplasia.

Endoscopic therapy for Barrett’s esophagus and early esophageal cancer: Where do we go from here?

“…The eradication response appears to be durable for up to 5 years. Over a follow up period of 5 years in 40 patients with HGD or EAC, complete remission of HGD, CE-D and CE-IM was seen in 93%, 88% and 75% of patients respectively[ 30 ]. Incidence of recurrent HGD/EAC was 1.4% per person years.…”

Salvage cryotherapy in patients undergoing endoscopic eradication therapy for complicated Barrett’s esophagus

“…Since the development and initial clinical use of esophageal cryotherapy in 1999 22 , studies in treatment-naive patients have demonstrated encouraging efficacy, safety, and durability 18 23 24 25 . In addition, because it can be applied to non-lifting and nodular tissue, cryotherapy has become increasingly popular as a salvage modality when patients are not candidates for, or have experienced suboptimal response to EMR, RFA, or the combination.…”

Feasibility of liquid nitrogen cryotherapy after failed radiofrequency ablation for Barrett's esophagus

“…However, this is a true RFA failure cohort as the patients included in this study had persistent intestinal metaplasia and/or dysplasia after at least four RFA procedures before being deemed a RFA failure (median RFA treatments was five). In addition, this is an initial efficacy and feasibility study and, as such, long‐term durability data are not provided here as in most initial efficacy and feasibility studies, as opposed to long‐term durability studies in cryotherapy and RFA The centers included in the present study are high‐volume BE referral centers with similar RFA and cryotherapy techniques and protocols, which limit the heterogeneity of the study. Finally, RFA failures are uncommon, as RFA is usually clinically successful.…”