title: Liquid nitrogen spray cryotherapy in Barrett's esophagus with high-grade dysplasia: long-term results.
abstract: BACKGROUND
  Liquid nitrogen endoscopic spray cryotherapy can safely and effectively eradicate high-grade dysplasia in Barrett's esophagus (BE-HGD). Long-term data on treatment success and safety are lacking.
  
  
  OBJECTIVE
  To assess the long-term safety and efficacy of spray cryotherapy in patients with BE-HGD.
  
  
  METHODS
  Single-center, retrospective study.
  
  
  METHODS
  Tertiary-care referral center.
  
  
  METHODS
  A total of 32 patients with BE-HGD of any length.
  
  
  METHODS
  Patients were treated with liquid nitrogen spray cryotherapy every 8 weeks until complete eradication of HGD (CE-HGD) and intestinal metaplasia (CE-IM) was found by endoscopic biopsy. Surveillance endoscopy with biopsies was performed for at least 2 years.
  
  
  METHODS
  CE-HGD, CE-IM, durability of response, disease progression, and adverse events.
  
  
  RESULTS
  CE-HGD was 100% (32/32), and CE-IM was 84% (27/32) at 2-year follow-up. At last follow-up (range 24-57 months), CE-HGD was 31/32 (97%), and CE-IM was 26/32 (81%). Recurrent HGD was found in 6 (18%), with CE-HGD in 5 after repeat treatment. One patient progressed to adenocarcinoma, downgraded to HGD after repeat cryotherapy. BE segment length ≥3 cm was associated with a higher recurrence of IM (P = .004; odds ratio 22.6) but not HGD. No serious adverse events occurred. Stricture was seen in 3 patients (9%), all successfully dilated.
  
  
  CONCLUSIONS
  Retrospective study design, small sample size.
  
  
  CONCLUSIONS
  In patients with BE-HGD, liquid nitrogen spray cryotherapy has an acceptable safety profile and success rate for eliminating HGD and IM and is associated with a low rate of recurrence or progression to cancer with long-term follow-up.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland, USA. sgosain@medicine.umaryland.edu
authors.forename: Sonia
authors.initials: S
authors.lastname: Gosain
authors.forename: Kim
authors.initials: K
authors.lastname: Mercer
authors.forename: William S
authors.initials: WS
authors.lastname: Twaddell
authors.forename: Lance
authors.initials: L
authors.lastname: Uradomo
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Greenwald
mesh_terms: D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery*; D003452:Cryosurgery / Q000379:methods*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009584:Nitrogen / Q000627:therapeutic use*; D011230:Precancerous Conditions / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D016896:Treatment Outcome
chemical_list: D009584:Nitrogen
keywords: BE; BE with high-grade dysplasia; BE-HGD; Barrett's esophagus; CE-HGD; CE-IM; HGD; IM; PPI; RFA; complete eradication of high-grade dysplasia; complete eradication of intestinal metaplasia; high-grade dysplasia; intestinal metaplasia; proton pump inhibitor; radiofrequency ablation