Safety and efficacy of endoscopic spray cryotherapy for Barrett's dysplasia: results of the National Cryospray Registry

Abstract

Retrospective series have shown the efficacy of endoscopic spray cryotherapy in eradicating high-grade dysplasia (HGD) in Barrett's esophagus (BE); however, prospective data are lacking, and efficacy for low-grade dysplasia (LGD) is unclear. The aim of this study was to assess the efficacy and safety of spray cryotherapy in patients with LGD or HGD. A multicenter, prospective open-label registry enrolled patients with dysplastic BE. Spray cryotherapy was performed every 2-3 months until there was no endoscopic evidence of BE and no histological evidence of dysplasia, followed by surveillance endoscopies up to 2 years. Primary outcome measures were complete eradication of dysplasia (CE-D) and complete eradication of all intestinal metaplasia (CE-IM). Ninety-six subjects with Barrett's dysplasia (67% HGD; 65% long-segment BE; mean length 4.5 cm) underwent 321 treatments (mean 3.3 per subject). Mean age was 67 years, 83% were male. Eighty patients (83%) completed treatment with follow-up endoscopy (mean duration 21 months). In patients with LGD, rate of CE-D was 91% (21/23) and rate of CE-IM was 61% (14/23). In HGD, CE-D rate was 81% (46/57) and CE-IM was 65% (37/57). In patients with short-segment BE (SSBE) with any dysplasia, CE-D was achieved in 97% (30/31) and CE-IM in 77% (24/31). There were no esophageal perforations or related deaths. One subject developed a stricture, which did not require dilation. One patient was hospitalized for bleeding in the setting of non-steroidal anti-inflammatory drug use. In the largest prospective cohort to date, data suggest endoscopic spray cryotherapy is a safe and effective modality for eradication of BE with LGD or HGD, particularly with SSBE.

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

“…In a retrospective study of 60 patients, 97% of patients achieved CE-HGD, 87% achieved CE-D, and 57% achieved CE-IM with mean follow-up of 10.5 months (3). A multicenter study from the National Cryospray Registry showed CE-D of 81% (46/57) and CE-IM of 65% (37/57) with mean follow-up of 21 months (5). We previously reported two year follow-up of a cohort of 32 patients with CE-HGD and CE-IM of 100% and 84%, respectively.…”

“…It is a safe, well-tolerated, and effective therapy for BE-associated HGD with rates of complete eradication of HGD (CE-HGD) ranging from 97% to 100%, complete eradication of dysplasia (CE-D) from 81% to 87%, and complete eradication of intestinal metaplasia (CE-IM) from 57% to 84% (3–5). Follow-up beyond 2 years for this modality is not available.…”

Barrett's esophagus: diagnosis and management

“…A newer device is also available to deliver cryotherapy using nitrous oxide via a self-contained, balloon based system [127]. Cryoablation can achieve complete eradication of HGD in a high proportion of patients with BE in retrospective studies, with good durability during a 24-month follow-up period [128, 129]. Similar efficacy was seen in prospective data with 81% to 94% eradication of HGD [130, 131].…”

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

“…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). A prospective cohort study of 80 patients with BE with LGD or HGD from the national cryospray (liquid nitrogen) registry (57) showed CE-D in 91% of patients with LGD and 81% of patients with HGD, while CE-IM was achieved in 61% of patients with LGD and 65% of patients with HGD. A retrospective study of CO 2 cryotherapy in 78 patients with neoplastic BE showed similar results, with CE-HGD in 94% of patients and CE-IM in 55% of patients (58).…”