Liquid nitrogen spray cryotherapy for eradication of dysplastic Barrett’s esophagus: results from a multicenter prospective registry - 16/07/24
, Cary C. Cotton, MD, MPH 1, 2, Vivek Kaul, MD 3, Matthew McKinley, MD 4, Douglas Pleskow, MD 5, Norman Nishioka, MD 6, Brenda Hoffman, MD 7, Jose Nieto, DO 8, Franklin Tsai, MD 9, Walter Coyle, MD 9, Shivangi Kothari, MD 3, Virendra Joshi, MD 10, John Dumot, DO 11, Bruce Greenwald, MD 12, Fadlallah G. Habr, MD 13, Nicholas J. Shaheen, MD, MPH 1, 2Abstract |
Background and Aims |
Liquid nitrogen spray cryotherapy (SCT) is an alternative to radiofrequency ablation (RFA) for eradication of dysplastic Barrett’s esophagus (BE). We aimed to assess the safety, efficacy, and durability of SCT in a multicenter U.S. registry.
Methods |
This is a multicenter prospective registry of adults with BE treated with truFreeze Spray Cryotherapy (Steris, Mentor, Ohio, USA) (4 community and 11 academic sites, 2013-2022). Complete eradication of intestinal metaplasia (CEIM) and dysplasia (CED) were assessed in BE with dysplasia or intramucosal adenocarcinoma. Kaplan-Meier analysis of CEIM and CED was performed. Hazard ratios for CEIM stratified by baseline risk factors were calculated.
Results |
Among 138 subjects with low-grade dysplasia (24%), high-grade dysplasia (49%), and intramucosal adenocarcinoma (27%), 34% received prior RFA therapy. Subjects received a median of 2 SCT sessions. Adverse events were uncommon, with 5.5% reporting strictures and 0.7% a perforation. Rates of CEIM and CED, respectively, were 66% and 84% after 2 years and 67% and 92% after 3 years. In RFA-naïve patients, CEIM was 77% and CED was 96% at 3 years. Increasing BE length (per centimeter: adjusted hazard ratio, 0.90; 95% confidence interval, 0.83-0.96) and prior treatment with RFA (adjusted hazard ratio, 0.39; 95% confidence interval, 0.22-0.69) were associated with a lower rate of CEIM. Recurrence occurred in 8.8% (n = 6) at a mean follow-up of 2.5 years after CEIM.
Conclusion |
In this largest reported prospective cohort, liquid nitrogen SCT was safe and effective for the treatment of dysplastic and neoplastic BE. Response was lower in those with prior failed RFA; in that cohort, approximately 50% attained CEIM at 3 years.
Le texte complet de cet article est disponible en PDF.Abbreviations : BE, CED, CEIM, CI, EET, HGD, IM, IMC, LGD, RFA, SCT
Plan
Vol 100 - N° 2
P. 200-209 - août 2024 Retour au numéro
Article précédent
- Administration of oral prednisolone to prevent esophageal stricture after balloon-type radiofrequency ablation for ultralong-segment esophageal neoplasia
- Wen-Lun Wang, Ying-Nan Tsai, Ming-Hung Hsu, Jaw-Town Lin, Hsiu-Po Wang, Ching-Tai Lee
- Freeze frame: Is spray cryotherapy the hot new thing for Barrett’s dysplasia?
- Drew Schembre
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