Safety and effectiveness of balloon cryoablation for treatment of Barrett’s associated neoplasia: systematic review and meta-analysis

Abstract

Background and study aims Balloon cryoablation (BC) is a novel procedure for endoscopic ablation of Barrett’s esophagus (BE- associated neoplasia. We performed a meta-analysis to assess the feasibility, effectiveness, and safety of BC for treatment of BE neoplasia. Patients and methods Several databases were searched for relevant articles (PubMed, Web of Science, Google Scholar, EMBASE) as well as abstracts of recent gastroenterology meetings. Data extraction was performed by two investigators using standardized forms, including age, gender, length of BE segment, prior treatments, procedural time and number ablation sessions, technical feasibility, adverse events, and eradication rates of intestinal metaplasia (CE-IM) and dysplasia (CE-D) at follow-up. Quality of the studies was assessed using a modified Newcastle Ottawa Scale. Results Seven studies met inclusion criteria for a total of 548 ablation sessions in 272 patients. The most common histopathology reported prior to BC was high-grade dysplasia (n = 131), followed by low-grade dysplasia (n = 75), and intramucosal adenocarcinoma (n = 52). The pooled rate for technical feasibility was 95.8 % (95 % CI: 93.6–97.5 %; I2 = 13.2 %; P = 0.3). Pooled rates of CE-IM and CE-D were 85.8 % (95 % CI: 77.8–92.2 %, I2 = 55.5 %; p = 0.04) and 93.8 % (95 % CI: 85.5–98.7 %, I2 = 74.2 %; P = 0.001), respectively. The overall adverse event (AE) rate was 12.5 % (34 out of 272 patients), of which stricture formation was the most common (5.8 %), followed by mucosal laceration (0.7 %), perforation (0.4 %), and bleeding (0.4 %). All AEs were successfully managed endoscopically. Conclusion This meta-analysis suggests that BC is a safe and effective ablative technique for treatment of BE neoplasia; future prospective comparative trials are needed to corroborate these initial findings.

S2k-Leitlinie Gastroösophageale Refluxkrankheit und eosinophile Ösophagitis der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – März 2023 – AWMF-Registernummer: 021–013

“…Die Kryotherapie wird in den USA und auch in Europa im Rahmen von Studien als alternatives Ablationsverfahren erfolgreich eingesetzt, ist aber in Europa bislang noch nicht verfügbar und zugelassen [458][459][460].…”

Endoscopic Diagnosis and Management of Barrett’s Esophagus with Low-Grade Dysplasia

“…The efficacy and safety of the most recent cryoablation technique, the Cryoballoon Ablation, was investigated in metanalysis conducted by Westervald et al [83], which demonstrated the achievement of complete eradication of metaplasia (CE-M) and CE-D in 88% and 94% of patients with LGD, respectively.…”

Interventional gastroenterology in oncology

“…49 The rate of complete eradication from cryoablation therapy in dysplastic BE has been reported at 87%-96%. 54 Cryotherapy has also been shown to be effective in patients who have early adenocarcinoma or IMCA, with complete remission reported in approximately 75% of patients, including those who failed other endoscopic treatments. 55…”

“…Cryoablation induces tissue destruction by the application of liquid nitrogen to the abnormal esophageal mucosa, which results in intensive, swift cooling and, ultimately, in tissue ischemia and apoptosis 49 . The rate of complete eradication from cryoablation therapy in dysplastic BE has been reported at 87%–96% 54 . Cryotherapy has also been shown to be effective in patients who have early adenocarcinoma or IMCA, with complete remission reported in approximately 75% of patients, including those who failed other endoscopic treatments 55 …”