Safety and Efficacy of Endoscopic Spray Cryotherapy for Barrett's Esophagus with High-Grade Dysplasia

Abstract

Background-Endoscopic ablation to treat Barrett's esophagus (BE) with high-grade dysplasia (HGD) is associated with a decreased incidence of esophageal adenocarcinoma. Endoscopic spray cryotherapy (CRYO) demonstrates promising preliminary data.Objective-To assess the safety and efficacy of CRYO in BE with HGD. Design-Multicenter, retrospective cohort study.Setting-Nine academic and community centers; treatment period, 2007 to 2009.Patients-Subjects with HGD confirmed by 2 pathologists. Previous EMR was allowed if residual HGD remained. Interventions-CRYO with follow-up biopsies.Main Outcome Measurements-Complete eradication of HGD with persistent low-grade dysplasia, complete eradication of all dysplasia with persistent nondysplastic intestinal metaplasia, and complete eradication of all intestinal metaplasia.Results-Ninety-eight subjects (mean age 65.4 years, 83% male) with BE and HGD (mean length 5.3 cm) underwent 333 treatments (mean 3.4 treatments per subject). There were no esophageal perforations. Strictures developed in 3 subjects. Two subjects reported severe chest pain managed with oral narcotics. One subject was hospitalized for bright red blood per rectum. Sixty subjects had completed all planned CRYO treatments and were included in the efficacy analysis. Fifty-eight subjects (97%) had complete eradication of HGD, 52 (87%) had complete eradication of all dysplasia with persistent nondysplastic intestinal metaplasia, and 34 (57%) had complete eradication of all intestinal metaplasia. Subsquamous BE was found in 2 subjects (3%).

Feasibility of spray cryotherapy and balloon dilation for non-malignant strictures of the airway

“…Table 1 demonstrates the number of repeat cryotherapy treatment sessions required related to initial stricture severity. The mean follow-up was 8.2 months (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] and was available in 33/35 patients. There were no perioperative deaths, but complications occurred after two procedures and included the need for a tracheostomy in one patient, and pneumothorax in another.…”

“…Spray cryotherapy (SC) is a new thermal energy platform that has been used extensively in the gastrointestinal tract and more recently reported in the airway [1][2][3]. Because the integrity of the extracellular matrix remains largely intact at the current dosimetries used with SC [3], and because an intact stroma provides the structural framework for appropriate wound repair, a fundamental shift in the wound response results in a more normative healing process [17,18].…”

Adverse events of upper GI endoscopy

“…The incidence of strictures ranges between 4% and 10%. [166][167][168] Esophageal perforation was reported in 1 patient with Marfan syndrome undergoing liquid nitrogen cryotherapy. 167 Endoscopic stents.…”

Endoscopic Management of Early Esophageal Neoplasia: an Emerging Standard

“…IM and dysplasia eradication rates are comparable to RFA in recent studies. 17 Cryoablation can be used as a primary modality or in conjunction with EMR and/or RFA to achieve IM/ neoplasia eradication, as reflected in our study.…”