Initial multicenter experience with nitrous oxide cryoballoon for treatment of flat duodenal adenomas (with video) - 02/09/20

Doi : 10.1016/j.gie.2020.05.048

Mohamad Dbouk, MD ^1,^2,^{^{∗
Drs Dbouk and Brewer contributed equally to this article.}}, Olaya Brewer Guiterrez, MD ^1,^{^{∗
Drs Dbouk and Brewer contributed equally to this article.}}, Arvind J. Trindade, MD ³, David L. Diehl, MD ⁴, Richard S. Kwon, MD ⁵, Nirav C. Thosani, MD ⁶, Harshit S. Khara, MD ⁴, Petros C. Benias, MD ³, Tossapol Kerdsirichairat, MD ⁴, Marcia Irene Canto, MD, MHS ^1,^⁎
¹ Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
² Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
³ Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USA
⁴ Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA
⁵ Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
⁶ Division of Gastroenterology, University of Texas Health Science Center at Houston, Houston, Texas, USA

^∗Reprint requests: Marcia Irene Canto, MD MHS, Johns Hopkins Medical Institutions, Department of Medicine, Division of Gastroenterology, 1800 Orleans Street, Blalock 407, Baltimore, MD 21287.Johns Hopkins Medical InstitutionsDepartment of MedicineDivision of Gastroenterology1800 Orleans StreetBlalock 407BaltimoreMD21287

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 02 September 2020

Abstract

Background and Aims

EMR is the preferred endoscopic therapy for duodenal adenomas (DAs) but is associated with an overall adverse event rate of 26%. Cryotherapy using a Cryoballoon Focal Ablation System (CbFAS) can safely and effectively eradicate esophageal intestinal metaplasia. We report our first experience with cryoballoon ablation for treatment of flat DAs.

Methods

This was an American, multicenter, retrospective study involving 5 centers. DAs (Paris 0-IIa and 0-IIb) were treated with nitrous oxide for 5 to 12 seconds using CbFAS. Follow-up EGD was performed at 3 to 12 months.

Results

Seventeen DAs (mean size, 22.7 ± 14.3 mm; 12 tubular, 5 tubulovillous) from 13 patients (mean age, 66.5 ± 9.99 years; 61.5% males) were included in the study. Thirteen of 17 DAs (76.5%) had failed previous treatment, and 4 of 17 (23.5%) were treatment naÏve. All procedures were technically successful and achieved a >50% decrease in size after cryoballoon ablation There was no increase in size or progression of disease for any lesions. Overall, treatment was completed in 15 of 17 patients, and recurrence-free survival was achieved in 12 of 17 (71%) after a median follow-up of 15.5 months (interquartile range [IQR], 6.8-19.4). The median cryoablation time per polyp was 4 minutes (IQR, 1-7.5 minutes), and the median total procedure time was 25 minutes (IQR, 22-30.5 minutes). There were no intra- or postprocedural adverse events.

Conclusions

Nitrous oxide cryoballoon ablation of nonpolypoid DAs is feasible, with promising safety and efficacy.

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Abbreviations : AE, APC, BE, CBA, CbFAS, DA, ESD, FAP, HGD, IQR, SDA

Plan

Outcomes and analysis

If you would like to chat with an author of this article, you may contact Dr Canto at mcanto1@jhmi.edu.

DISCLOSURE: Dr Canto has received research grants from Pentax Medical and Endogastric Solutions, has ownership interest (royalties) in UpToDate, and has served as a consultant for Exigo Management Consultants and Exact Science. Dr Trindade has received a research grant from Ninepoint Medical and has served as a consultant for Pentax Medical and Olympus. Dr Diehl has served as a consultant for Pentax Medical, Olympus, Cook Medical, Boston Scientific, and Medtronic. Dr Thosani is consultant for Boston Scientific Corporation, Medtronic, and Pentax America; receives royalties from UpToDate; and is a speaker for Abbvie. Dr Khara has received a research grant from and has served as a consultant for Pentax Medical. Dr Benias is associated with Olympus, Fujinon, Medtronic, and Apollo Endosurgery. All other authors disclosed no financial relationships.