title: Safety and efficacy of endoscopic spray cryotherapy for Barrett's dysplasia: results of the National Cryospray Registry.
abstract: Retrospective series have shown the efficacy of endoscopic spray cryotherapy in eradicating high-grade dysplasia (HGD) in Barrett's esophagus (BE); however, prospective data are lacking, and efficacy for low-grade dysplasia (LGD) is unclear. The aim of this study was to assess the efficacy and safety of spray cryotherapy in patients with LGD or HGD. A multicenter, prospective open-label registry enrolled patients with dysplastic BE. Spray cryotherapy was performed every 2-3 months until there was no endoscopic evidence of BE and no histological evidence of dysplasia, followed by surveillance endoscopies up to 2 years. Primary outcome measures were complete eradication of dysplasia (CE-D) and complete eradication of all intestinal metaplasia (CE-IM). Ninety-six subjects with Barrett's dysplasia (67% HGD; 65% long-segment BE; mean length 4.5 cm) underwent 321 treatments (mean 3.3 per subject). Mean age was 67 years, 83% were male. Eighty patients (83%) completed treatment with follow-up endoscopy (mean duration 21 months). In patients with LGD, rate of CE-D was 91% (21/23) and rate of CE-IM was 61% (14/23). In HGD, CE-D rate was 81% (46/57) and CE-IM was 65% (37/57). In patients with short-segment BE (SSBE) with any dysplasia, CE-D was achieved in 97% (30/31) and CE-IM in 77% (24/31). There were no esophageal perforations or related deaths. One subject developed a stricture, which did not require dilation. One patient was hospitalized for bleeding in the setting of non-steroidal anti-inflammatory drug use. In the largest prospective cohort to date, data suggest endoscopic spray cryotherapy is a safe and effective modality for eradication of BE with LGD or HGD, particularly with SSBE.
authors.affiliation: Department of Gastroenterology, Scripps Clinic, La Jolla, CA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Ghorbani
authors.affiliation: Department of Gastroenterology, Scripps Clinic, La Jolla, CA, USA.
authors.forename: F C
authors.initials: FC
authors.lastname: Tsai
authors.affiliation: Department of Gastroenterology, University of Maryland School of Medicine and Greenebaum Cancer Center, Baltimore, MD, USA.
authors.forename: B D
authors.initials: BD
authors.lastname: Greenwald
authors.affiliation: Department of Gastroenterology, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: S
authors.initials: S
authors.lastname: Jang
authors.affiliation: Department of Gastroenterology, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Dumot
authors.affiliation: Department of Gastroenterology, North Shore LIJ Health System and ProHEALTHcare Associates, Syosset and Lake Success, Nassau County, NY, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: McKinley
authors.affiliation: Department of Gastroenterology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: N J
authors.initials: NJ
authors.lastname: Shaheen
authors.affiliation: Department of Gastroenterology, Alpert School of Medicine of Brown University, Providence, RI, USA.
authors.forename: F
authors.initials: F
authors.lastname: Habr
authors.affiliation: Department of Gastroenterology, Scripps Clinic, La Jolla, CA, USA.
authors.forename: W J
authors.initials: WJ
authors.lastname: Coyle
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods; D017679:Cryotherapy / Q000379:methods*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009584:Nitrogen / Q000008:administration & dosage / Q000737:chemistry; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome
chemical_list: D009584:Nitrogen
keywords: Barrett esophagus; cryotherapy; endoscopy; esophageal neoplasm; human