Liquid Nitrogen Spray Cryotherapy is Associated With Less Postprocedural Pain Than Radiofrequency Ablation in Barrett’s Esophagus

Solomon, Sanjeev; Kothari, Shivangi; Smallfield, George; Inamdar, Sumant; Stein, Peter H.; Rodríguez, Viviana; Sima, Adam P.; Bittner, Krystle; Zfass, Alvin M.; Kaul, Vivek; Trindade, Arvind J.

doi:10.1097/mcg.0000000000000999

Cited by 42 publications

(33 citation statements)

References 32 publications

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“…A major advantage compared with RFA is that cryoablation seems to be less painful than RFA. 20 , 21 In addition, a recent study indicates that it also has a lower stricture rate. 20 …”

Section: Indication For Endoscopic Therapymentioning

confidence: 99%

“…However, complete eradication of dysplasia was observed in 87–96% and complete ablation of Barrett’s mucosa in 57–96% of patients. 20 – 23 Cryotherapy was also effective in patients with early Barrett’s adenocarcinoma with complete remission in 75%, including patients who have failed other endoscopic treatments 21 , 23 ( Figure 4 ).…”

Section: Indication For Endoscopic Therapymentioning

confidence: 99%

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Update on endoscopic treatment of Barrett’s oesophagus and Barrett’s oesophagus–related neoplasia

Pech

Alqahtani

2020

Clin Med Insights Gastroenterol

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Endoscopic therapy of early Barrett’s oesophagus–related neoplasia is the treatment of choice for low-grade-dysplasia, high-grade dysplasia and mucosal Barrett’s cancer. Low-grade-dysplasia without any visible lesion should be ablated, preferably with radiofrequency ablation. In cases with the presence of a visible lesion, high-grade dysplasia and early Barrett’s adenocarcinoma, endoscopic resection techniques like multiband ligation endoscopic resection or endoscopic submucosal dissection should be applied. After complete resection of all visible neoplastic lesions, ablation of the remaining Barrett’s oesophagus should be performed to prevent recurrence. Ablation techniques available are radiofrequency ablation, argon plasma coagulation and cryoablation.

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“…A major advantage compared with RFA is that cryoablation seems to be less painful than RFA. 20 , 21 In addition, a recent study indicates that it also has a lower stricture rate. 20 …”

Section: Indication For Endoscopic Therapymentioning

confidence: 99%

Section: Indication For Endoscopic Therapymentioning

confidence: 99%

Update on endoscopic treatment of Barrett’s oesophagus and Barrett’s oesophagus–related neoplasia

Pech

Alqahtani

2020

Clin Med Insights Gastroenterol

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“…Endoscopic cryoablation is another option for ablative therapy that has emerged in the past decade, with recent studies suggesting less postprocedural chest pain and better patient tolerance compared with RFA. 60,61 At least 2 platforms for cryotherapy are now commercially available and in use. In the case of spray cryotherapy ( Figure 6D), liquid nitrogen is delivered at e196 C (e320 F) through a novel spray catheter, which is introduced through the working channel of a standard endoscope.…”

Section: Ablation Modalitiesmentioning

confidence: 99%

Barrett Esophagus

Iyer

Kaul

2019

Mayo Clinic Proceedings

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The target audience for Mayo Clinic Proceedings is primarily internal medicine physicians and other clinicians who wish to advance their current knowledge of clinical medicine and who wish to stay abreast of advances in medical research. Statement of Need: General internists and primary care physicians must maintain an extensive knowledge base on a wide variety of topics covering all body systems as well as common and uncommon disorders. Mayo Clinic Proceedings aims to leverage the expertise of its authors to help physicians understand best practices in diagnosis and management of conditions encountered in the clinical setting. Accreditation: In support of improving patient care, Mayo Clinic College of Medicine and Science is accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team. Credit Statement: Mayo Clinic College of Medicine and Science designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s).ä Physicians should claim only the credit commensurate with the extent of their participation in the activity. MOC Credit Statement: Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1 MOC point in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. Learning Objectives: On completion of this article, you should be able to (1) obtain state of the art information related to screening and surveillance in Barrett esophagus, (2) acquire a good understanding of the various modalities of treatment available for dysplastic Barrett esophagus and early esophageal neoplasia, and (3) identify the key best practices and guideline based recommendations for management of Barrett esophagus. Disclosures: As a provider accredited by ACCME, Mayo Clinic College of Medicine and Science (Mayo School of Continuous Professional Development) must ensure balance, independence, objectivity, and scientific rigor in its educational activities. Course Director(s), Planning Committee members, Faculty, and all others who are in a position to control the content of this educational activity are required to disclose all relevant financial relationships with any commercial interest related to the subject matter of the educational activity. Safeguards against commercial bias have been put in place. Faculty also will disclose any off-label and/or investigational use of pharmaceuticals or instruments discussed in their presentation. Disclosure of this information will be published in course materials so that those participants in the activity may formulate their...

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“…There are now two delivery systems available: a spray catheter[77-86] and a balloon based device[87-89]. While the number of published trials using cryotherapy currently pales in comparison to RFA, the potential theoretical advantages of cryotherapy may be better patient tolerance[80], slightly less stricture rate[90] and deeper penetration of cold energy[91] . Spray cryotherapy appears to be able to salvage approximately 50% of dysplastic Barrett’s cases refractory to RFA[92] and provide a reasonable complete remission of dysplasia (CR-D) in 76% of naïve patients[77].…”

Section: Be and Early Esophageal Cancermentioning

confidence: 99%

Endoscopic foregut surgery and interventions: The future is now. The state-of-the-art and my personal journey

Chang

2019

WJG

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In this paper, I reviewed the emerging field of endoscopic surgery and present data supporting the contention that endoscopy can now be used to treat many foregut diseases that have been traditionally treated surgically. Within each topic, the content will progress as follows: “lessons learned”, “technical considerations” and “future opportunities”. Lessons learned will provide a brief background and update on the most current literature. Technical considerations will include my personal experience, including tips and tricks that I have learned over the years. Finally, future opportunities will address current unmet needs and potential new areas of development. The foregut is defined as “the upper part of the embryonic alimentary canal from which the pharynx, esophagus, lung, stomach, liver, pancreas, and part of the duodenum develop”. Foregut surgery is well established in treating conditions such as gastroesophageal reflux disease (GERD), achalasia, esophageal diverticula, Barrett’s esophagus (BE) and esophageal cancer, stomach cancer, gastric-outlet obstruction, and obesity. Over the past decade, remarkable progress in interventional endoscopy has culminated in the conceptualization and practice of endoscopic foregut surgery for various clinical conditions summarized in this paper. Regarding GERD, there are now several technologies available to effectively treat it and potentially eliminate symptoms, and the need for long-term treatment with proton pump inhibitors. For the first time, fundoplication can be performed without the need for open or laparoscopic surgery. Long-term data going out 5-10 years are now emerging showing extended durability. In respect to achalasia, per-oral endoscopic myotomy (POEM) which was developed in Japan, has become an alternative to the traditional Heller’s myotomy. Recent meta-analysis show that POEM may have better results than Heller, but the issue of post-POEM GERD still needs to be addressed. There is now a resurgence of endoscopic treatment of Zenker’s diverticula with improved technique (Z-POEM) and equipment; thus, patients are choosing flexible endoscopic treatment as opposed to open or rigid endoscopy options. In regard to BE, endoscopic submucosal dissection (ESD) which is well established in Asia, is now becoming more mainstream in the West for the treatment of BE with high grade dysplasia, as well as early esophageal cancer. In combination with all the ablation technologies (radiofrequency ablation, cryotherapy, hybrid argon plasma coagulation), the entire spectrum of Barrett’s and related dysplasia and early cancer can be managed predominantly by endoscopy. Importantly, in regard to early gastric cancer and submucosal tumors (SMTs) of the stomach, ESD and full thickness resection (FTR) can excise these lesions en-bloc and endoscopic suturing is now used to close large defects and perforations. For treatment of patients with malignant gastric outlet obstruction (GOO), endoscopic gastro-jejunostomy is now showing better results ...

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Liquid Nitrogen Spray Cryotherapy is Associated With Less Postprocedural Pain Than Radiofrequency Ablation in Barrett’s Esophagus

Abstract: LNC was associated with less postprocedural pain when compared with RFA. These results help inform patients and physicians about the expected symptoms after ablative endotherapy.

Cited by 42 publications

References 32 publications

Update on endoscopic treatment of Barrett’s oesophagus and Barrett’s oesophagus–related neoplasia

Update on endoscopic treatment of Barrett’s oesophagus and Barrett’s oesophagus–related neoplasia

Barrett Esophagus

Endoscopic foregut surgery and interventions: The future is now. The state-of-the-art and my personal journey

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