title: Safety and efficacy of endoscopic spray cryotherapy for Barrett's esophagus with high-grade dysplasia.
abstract: BACKGROUND
  Endoscopic ablation to treat Barrett's esophagus (BE) with high-grade dysplasia (HGD) is associated with a decreased incidence of esophageal adenocarcinoma. Endoscopic spray cryotherapy (CRYO) demonstrates promising preliminary data.
  
  
  OBJECTIVE
  To assess the safety and efficacy of CRYO in BE with HGD.
  
  
  METHODS
  Multicenter, retrospective cohort study.
  
  
  METHODS
  Nine academic and community centers; treatment period, 2007 to 2009.
  
  
  METHODS
  Subjects with HGD confirmed by 2 pathologists. Previous EMR was allowed if residual HGD remained.
  
  
  METHODS
  CRYO with follow-up biopsies.
  
  
  METHODS
  Complete eradication of HGD with persistent low-grade dysplasia, complete eradication of all dysplasia with persistent nondysplastic intestinal metaplasia, and complete eradication of all intestinal metaplasia.
  
  
  RESULTS
  Ninety-eight subjects (mean age 65.4 years, 83% male) with BE and HGD (mean length 5.3 cm) underwent 333 treatments (mean 3.4 treatments per subject). There were no esophageal perforations. Strictures developed in 3 subjects. Two subjects reported severe chest pain managed with oral narcotics. One subject was hospitalized for bright red blood per rectum. Sixty subjects had completed all planned CRYO treatments and were included in the efficacy analysis. Fifty-eight subjects (97%) had complete eradication of HGD, 52 (87%) had complete eradication of all dysplasia with persistent nondysplastic intestinal metaplasia, and 34 (57%) had complete eradication of all intestinal metaplasia. Subsquamous BE was found in 2 subjects (3%).
  
  
  CONCLUSIONS
  Nonrandomized, retrospective study with no control group, short follow-up (10.5 months), lack of centralized pathology, and use of surrogate outcome for decreased cancer risk.
  
  
  CONCLUSIONS
  CRYO is a safe and well-tolerated therapy for BE and HGD. Short-term results suggest that CRYO is highly effective in eradicating HGD.
authors.affiliation: Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599-7080, USA.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Shaheen
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Greenwald
authors.forename: Anne F
authors.initials: AF
authors.lastname: Peery
authors.forename: John A
authors.initials: JA
authors.lastname: Dumot
authors.forename: Norman S
authors.initials: NS
authors.lastname: Nishioka
authors.forename: Herbert C
authors.initials: HC
authors.lastname: Wolfsen
authors.forename: J Steven
authors.initials: JS
authors.lastname: Burdick
authors.forename: Julian A
authors.initials: JA
authors.lastname: Abrams
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Wang
authors.forename: Damien
authors.initials: D
authors.lastname: Mallat
authors.forename: Mark H
authors.initials: MH
authors.lastname: Johnston
authors.forename: Alvin M
authors.initials: AM
authors.lastname: Zfass
authors.forename: Jenny O
authors.initials: JO
authors.lastname: Smith
authors.forename: James S
authors.initials: JS
authors.lastname: Barthel
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Lightdale
mesh_terms: D000336:Aerosols; D000368:Aged; D001471:Barrett Esophagus / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D001706:Biopsy; D002637:Chest Pain / Q000209:etiology; D015331:Cohort Studies; D003452:Cryosurgery / Q000379:methods*; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D004940:Esophageal Stenosis / Q000209:etiology; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011230:Precancerous Conditions / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000336:Aerosols