title: Salvage cryotherapy after failed radiofrequency ablation for Barrett's esophagus-related dysplasia is safe and effective.
abstract: BACKGROUND
  Radiofrequency ablation (RFA) is an effective treatment for Barrett's esophagus (BE) dysplasia. For patients with dysplasia refractory to RFA, data are limited regarding efficacy of endoscopic therapy.
  
  
  OBJECTIVE
  To assess the efficacy and safety of cryotherapy in patients with BE dysplasia who failed RFA.
  
  
  METHODS
  Single-center, retrospective, cohort study.
  
  
  METHODS
  Tertiary-care center between 2006 and 2013.
  
  
  METHODS
  Patients with BE and low-grade dysplasia (LGD), high-grade dysplasia (HGD), or intramucosal carcinoma (IMC) were referred for RFA every 2 to 3 months. Response was determined by complete eradication of dysplasia (CE-D).
  
  
  METHODS
  Patients without CE-D or those with recurrent dysplasia after initial eradication were offered cryotherapy.
  
  
  METHODS
  Eradication of dysplasia and/or cancer. Secondary outcome, eradication of intestinal metaplasia.
  
  
  RESULTS
  A total of 121 patients underwent RFA for BE dysplasia (55% HGD, 26% LGD, 17% IMC, 2% indefinite dysplasia). After a median of 3 RFA sessions, 75% (n = 91) had CE-D. Patients without CE-D were more likely to have a longer BE length (7 cm vs 4 cm; P = .004) and a hiatal hernia (83% vs 55%; P = .005). Sixteen patients (14 with failed CE-D and 2 with recurrent dysplasia) were offered cryotherapy and had endoscopic follow-up. Seven (57%) had HGD before cryotherapy (6 with LGD, 2 with IMC, and 1 with indefinite dysplasia). After cryotherapy, 12 (75%) had CE-D, and 5 (31%) had eradication of intestinal metaplasia. Of patients with IMC, 100% had CE-D. Three patients developed strictures that responded to dilation.
  
  
  CONCLUSIONS
  Single center, retrospective nature of study.
  
  
  CONCLUSIONS
  For patients with refractory dysplasia or recurrent dysplasia after RFA, salvage cryotherapy is a safe and effective endoscopic therapy.
authors.affiliation: Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Sengupta
authors.affiliation: Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Gyanprakash A
authors.initials: GA
authors.lastname: Ketwaroo
authors.affiliation: Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Bak
authors.affiliation: Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Vikram
authors.initials: V
authors.lastname: Kedar
authors.affiliation: Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Ram
authors.initials: R
authors.lastname: Chuttani
authors.affiliation: Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Tyler M
authors.initials: TM
authors.lastname: Berzin
authors.affiliation: Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Mandeep S
authors.initials: MS
authors.lastname: Sawhney
authors.affiliation: Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Pleskow
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D065311:Adenocarcinoma in Situ / Q000473:pathology / Q000601:surgery*; D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation; D015331:Cohort Studies; D003452:Cryosurgery / Q000379:methods*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D017211:Treatment Failure; D016896:Treatment Outcome