title: Treatment of Barrett's esophagus with a novel focal cryoablation device: a safety and feasibility study.
abstract: OBJECTIVE
  Currently, eradication of Barrett's epithelium is preferably achieved using radiofrequency ablation (RFA) or spray cryoablation (SCA). However, both modalities suffer from drawbacks such as the need for sizing, multiple deployment steps, large controller units (RFA), imprecise dosing and need for gas-venting (SCA). The new Cryoballoon Focal Ablation System (CbFAS) may address these limitations. This study assessed the safety, feasibility, and dose response of the CbFAS in patients with flat Barrett's epithelium with or without dysplasia.
  
  
  METHODS
  In this multicenter, prospective non-randomized trial, 39 patients were each treated with one or two ablations of 6, 8, or 10 seconds. Symptoms were assessed immediately and 2 days post-cryoablation. Follow-up endoscopy was performed 6-8 weeks post-procedure to assess response. Outcome parameters were incidence of adverse events, pain, esophageal stricture formation, and ablation response by cryogen dose.
  
  
  RESULTS
  Of 62 ablations, 56 (10 with 6 seconds, 28 with 8 seconds, 18 with 10 seconds) were successfully performed. Six ablations failed because of device malfunction (n=3) and procedural or anatomic issues (n=3). Median procedure time was 7 minutes (interquartile range [IQR] 4-10). No major adverse events occurred; six patients experienced a minor mucosal laceration requiring no intervention. Mild pain was reported by 27% of patients immediately after cryoablation and by 14% after 2 days. No strictures were evident at follow-up.  Full squamous regeneration was seen in 47 treated areas (6 [60%] of the 6-second areas; 23 [82%] of the 8-second areas; 18 [100%] of 10-second areas).
  
  
  CONCLUSIONS
  Focal cryoablation of Barrett's epithelium with the CbFAS is feasible and safe, resulting in squamous regeneration in the majority of patients.
authors.affiliation: St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Dirk W
authors.initials: DW
authors.lastname: Schölvinck
authors.affiliation: St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Hannah T
authors.initials: HT
authors.lastname: Künzli
authors.affiliation: University Medical Center, Utrecht, The Netherlands.
authors.forename: Christine
authors.initials: C
authors.lastname: Kestens
authors.affiliation: University Medical Center, Utrecht, The Netherlands.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
authors.affiliation: University Medical Center, Utrecht, The Netherlands.
authors.forename: Frank P
authors.initials: FP
authors.lastname: Vleggaar
authors.affiliation: Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Marcia Irene
authors.initials: MI
authors.lastname: Canto
authors.affiliation: Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Hilary
authors.initials: H
authors.lastname: Cosby
authors.affiliation: Columbia University Medical Center, New York, New York, USA.
authors.forename: Julian A
authors.initials: JA
authors.lastname: Abrams
authors.affiliation: Columbia University Medical Center, New York, New York, USA.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Lightdale
authors.affiliation: Columbia University Medical Center, New York, New York, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Tejeda-Ramirez
authors.affiliation: University of Southern California, Los Angeles, California, USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: DeMeester
authors.affiliation: University of Southern California, Los Angeles, California, USA.
authors.forename: Christine L
authors.initials: CL
authors.lastname: Greene
authors.affiliation: Canonsburg General Hospital, Canonsburg, Pennsylvania, USA.
authors.forename: Blair A
authors.initials: BA
authors.lastname: Jobe
authors.affiliation: University of Rochester, Rochester, New York, USA.
authors.forename: Jeff
authors.initials: J
authors.lastname: Peters
authors.affiliation: Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Jacques J G H M
authors.initials: JJ
authors.lastname: Bergman
authors.affiliation: St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Bas L A M
authors.initials: BL
authors.lastname: Weusten
mesh_terms: D000368:Aged; D001471:Barrett Esophagus / Q000175:diagnosis / Q000601:surgery; D003452:Cryosurgery / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D004945:Esophagoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D004947:Esophagus / Q000473:pathology / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010149:Postoperative Pain / Q000175:diagnosis*; D016896:Treatment Outcome