Safety and efficacy of endoscopic spray cryotherapy for Barrett's esophagus with high-grade dysplasia

Shaheen, Nicholas J.; Greenwald, Bruce D.; Peery, Anne F.; Dumot, John A.; Nishioka, Norman S.; Wolfsen, Herbert C.; Burdick, J. Steven; Abrams, Julian A.; Wang, Kenneth K.; Mallat, Damien; Johnston, Mark; Zfass, Alvin M.; Smith, Jenny O.; Barthel, James S.; Lightdale, Charles J.

doi:10.1016/j.gie.2010.01.018

Cited by 254 publications

(151 citation statements)

References 16 publications

(17 reference statements)

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“…Th is recommendation may change as further data become available. Promising cohort data on cryotherapy demonstrate high rates of CEIM and neoplasia ( 167,168 ).…”

Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,338

1,412

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Recent population studies suggest that gastroesophageal refl ux disease (GERD) is increasing in prevalence, both in the United States and worldwide ( 1,2 ). Th e diagnosis of GERD is associated with a 10-15% risk of Barrett's esophagus (BE), a change of the normal squamous epithelium of the distal esophagus to a columnar-lined intestinal metaplasia (IM). Risk factors associated with the development of BE include long-standing GERD, male gender, central obesity ( 3 ), and age over 50 years ( 4,5 ). Th e goal of a screening and surveillance program for BE is to identify individuals at risk for progression to esophageal adenocarcinoma (EAC), a malignancy that has been increasing in incidence since the 1970s ( 6,7 ).Th e purpose of this guideline is to review the defi nition and epidemiology of BE, available screening modalities for BE detection, rationale and methods for surveillance, and available treatment modalities including medical, endoscopic, and surgical techniques. In order to evaluate the level of evidence and strength of recommendations, we used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system ( 8 ). Th e level of evidence ranged from "high" (implying that further research was unlikely to change the authors' confi dence in the estimate of the eff ect) to "moderate" (further research would be likely to have an impact on the confi dence in the estimate of eff ect) to "low" (further research would be expected to have an important impact on the confi dence in the estimate of the eff ect and would be likely to change the estimate) or "very low" (any estimate of eff ect is very uncertain). Th e strength of a recommendation was graded as "strong" when the desirable eff ects of an intervention clearly outweighed the undesirable eff ects and as "conditional" when there was uncertainty about the tradeoff s. We used meta-analyses or systematic reviews when available, followed by clinical trials and cohort and case-control studies. In order to determine the level Barrett's esophagus (BE) is among the most common conditions encountered by the gastroenterologist. In this document, the American College of Gastroenterology updates its guidance for the best practices in caring for these patients. These guidelines continue to endorse screening of high-risk patients for BE; however, routine screening is limited to men with refl ux symptoms and multiple other risk factors. Acknowledging recent data on the low risk of malignant progression in patients with nondysplastic BE, endoscopic surveillance intervals are attenuated in this population; patients with nondysplastic BE should undergo endoscopic surveillance no more frequently than every 3-5 years. Neither routine use of biomarker panels nor advanced endoscopic imaging techniques (beyond high-defi nition endoscopy) is recommended at this time. Endoscopic ablative therapy is recommended for patients with BE and high-grade dysplasia, as well as T1a esophageal adenocarcinoma. Based on recent level 1 evidence, endoscopic ablative therapy is ...

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“…Th is recommendation may change as further data become available. Promising cohort data on cryotherapy demonstrate high rates of CEIM and neoplasia ( 167,168 ).…”

Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,338

1,412

View full text Add to dashboard Cite

show abstract

“…Short term studies have shown a safety and efficacy profile similar to other ablative techniques (171)(172)(173). In a single center study with 32 patients, complete eradication (CE) of HGD was 100 %, and CE of IM was 84 % at 2-year follow-up.…”

Section: Cryotherapymentioning

confidence: 94%

Endoscopic diagnosis and therapies for Barrett esophagus: a review

Waxman

González-Haba-Ruiz

Vázquez-Sequeiros

2014

Rev. esp. enferm. dig.

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“…The best available evidence is provided from cohort studies. A retrospective cohort study of 96 patients with BE with HGD treated with liquid nitrogen cryotherapy showed that 97% achieved complete eradication of HGD (CE-HGD), 87% had CE-D, and 57% had CE-IM (55). A small study of 32 patients designed to assess the long-term (2 year follow up) safety and efficacy of spray cryotherapy (liquid nitrogen) for BE with HGD demonstrated 100% CE-HGD and 84% CE-IM at 2-year follow-up, with recurrent HGD noted in 16% of patients (56).…”

Section: Cryotherapymentioning

confidence: 99%

Barrett’s esophagus: best practices for treatment and post-treatment surveillance

Mansour

El–Serag

Anandasabapathy

2017

Ann. Cardiothorac. Surg.

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Barrett's esophagus (BE) is a premalignant condition that increases the risk of esophageal adenocarcinoma (EAC). Significantly more common in the Western world, risk factors include increased age, male sex, white race, gastro-esophageal reflux disease (GERD), central obesity, and cigarette smoking. The rates of progression to cancer depend on the grade of Barrett's dysplasia. Screening for BE is recommended in patients with GERD and additional risk factors. Endoscopic surveillance of patients with BE likely improves overall outcomes. Advanced endoscopic imaging can help increase the efficiency of current endoscopic surveillance.Endoscopic therapy is safe and effective for the treatment of dysplastic BE and intramucosal EAC, but ongoing surveillance following treatment is necessary. This review will cover screening, surveillance, advanced imaging, chemoprevention, endoscopic treatment, and post-treatment surveillance of BE.

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Safety and efficacy of endoscopic spray cryotherapy for Barrett's esophagus with high-grade dysplasia

Cited by 254 publications

References 16 publications

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Endoscopic diagnosis and therapies for Barrett esophagus: a review

Barrett’s esophagus: best practices for treatment and post-treatment surveillance

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