Safety and efficacy of endoscopic spray cryotherapy for Barrett's esophagus with high-grade dysplasia.
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.
Shaheen
Nicholas J
NJ
Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599-7080, USA.
Greenwald
Bruce D
BD
Peery
Anne F
AF
Dumot
John A
JA
Nishioka
Norman S
NS
Wolfsen
Herbert C
HC
Burdick
J Steven
JS
Abrams
Julian A
JA
Wang
Kenneth K
KK
Mallat
Damien
D
Johnston
Mark H
MH
Zfass
Alvin M
AM
Smith
Jenny O
JO
Barthel
James S
JS
Lightdale
Charles J
CJ
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
D000336:Aerosols