Cryoballoon Ablation Can Be Used for Barrett’s Esophagus Endoscopic Therapy

Cryoballoon Ablation Can Be Used for Barrett’s Esophagus Endoscopic Therapy

Prateek Sharma, MD, FASGE, reviewing Canto MI, et al. Am J Gastroenterol 2020 Sep 28.

Cryotherapy involves the application of a cryogen by way of spraying liquid nitrogen to the esophageal mucosa or by surface contact with a nitrous oxide-filled endoscopic balloon. The authors of this study conducted a multicenter (11 centers) prospective trial to evaluate the performance outcomes for multifocal cryoballoon ablation (CBA) as Barrett’s esophagus endoscopic therapy (BET). 

A total of 120 patients (mean age, 65 years; 85% male; mean BE length, C1M3) with BE (low-grade dysplasia, 23%; high-grade dysplasia [HGD], 56%; esophageal adenocarcinoma [EAC], 20%) were enrolled (intention-to-treat [ITT] group), and 94 patients (mean age, 65 years; 83% male; mean BE length, C1M3) completed therapy and follow-up evaluation at 12 months (per-protocol [PP] group; 17 dropped out; 9 protocol deviations). The percentage of patients who underwent EMR prior to CBA was 46%. The rates of complete eradication of dysplasia (CE-D) and intestinal metaplasia (CE-IM) in the ITT group were 76% and 72% (PP group, 97% and 91%), respectively. Univariate analysis of the PP group suggested that patients with Prague M <3 cm were more likely to achieve CE-IM compared to Prague M >3 cm (98% vs 80%; P=.004). 

Of the 303 CBA treatment procedures, 13 (4.2%) were terminated due to technical/device failure. Three patients underwent radiofrequency ablation due to difficulty in the positioning of the cryoballoon, 2 patients with HGD failed to respond to CBA at 1 year, and 1 patient with baseline HGD progressed to EAC during the study. Fifteen patients (12.5%) had symptomatic strictures requiring dilation, 1 patient had a GI bleed (ongoing clopidogrel use), 1 had perforation related to dilation of a stricture from CBA, and 1 had a deep laceration with no subsequent need for intervention. Using the visual analog scale, pain was reported as 2 (interquartile range [IQR], 2-5), 1 (IQR, 0-2), and 0 (IQR, 0-0) in the recovery room at days 1 and 7 post-CBA.

Prateek Sharma, MD, FASGE

COMMENT

Using this new cryoballoon, multifocal ablation can be performed of the non-nodular dysplastic BE. In this single-arm study, complete eradication rates using this BET were 72%, with a 12.5% stricture rate. Further randomized controlled trials with alternate modalities will help understand its role among the existing BET techniques.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Canto MI, Trindade AJ, Abrams J, et al.  Multifocal cryoballoon ablation for eradication of Barrett’s esophagus-related neoplasia: a prospective multicenter clinical trial. Am J Gastroenterol 2020 Sep 28. (Epub ahead of print) (https://doi.org/10.14309/ajg.0000000000000822)

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