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

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.