Salvage cryotherapy after failed radiofrequency ablation for Barrett’s esophagus–related dysplasia is safe and effective

Sengupta, Neil; Ketwaroo, Gyanprakash A.; Bąk, Daniel; Kedar, Vikram; Chuttani, Ram; Berzin, Tyler M.; Sawhney, Mandeep S.; Pleskow, Douglas K.

doi:10.1016/j.gie.2015.01.033

Cited by 52 publications

(39 citation statements)

References 16 publications

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“…Our data showed a more robust response to LNC compared to the data of Sengupta et al . which were 75% and 31% respectively, although this is not statistically significant because of the similar numbers in both cohorts (18 vs 16 patients) . However, these results support the use of LNC in this challenging cohort of patients.…”

Section: Discussionmentioning

confidence: 66%

“…In an editorial by Weusten and Bergman, regarding the Sengupta study, they asserted that cryotherapy may not be effective for RFA failures as the goal is to eradicate intestinal metaplasia given the CE‐IM rate was 31% in that study. The title of their editorial stated, ‘Don't embrace the cold too soon’.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, Sengupta et al . reported their experience with liquid nitrogen cryotherapy (LNC) as salvage therapy for RFA failures in 16 patients with refractory dysplasia . They found LNC was able to achieve CE‐D in 75% (12/16) of patients and CE‐IM in 31% (5/16) of patients.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of liquid nitrogen cryotherapy after failed radiofrequency ablation for Barrett's esophagus

Trindade

Inamdar

Kothari

et al. 2017

Digestive Endoscopy

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

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Feasibility of liquid nitrogen cryotherapy after failed radiofrequency ablation for Barrett's esophagus

Trindade

Inamdar

Kothari

et al. 2017

Digestive Endoscopy

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“…BE refractory to endoscopic therapy has been documented in various studies with overall rate ranging from 2 % to 25 % [12,17].…”

Section: E891mentioning

confidence: 99%

Cryoballoon ablation for treatment of patients with refractory esophageal neoplasia after first line endoscopic eradication therapy

et al. 2020

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Abstract Background and study aims Cryoablation with the Cryoballoon device is a novel ablative therapy that uses cycles of freezing and thawing to induce cell death. This single-center prospective study evaluated the feasibility of the focal cryoablation device for the treatment of areas of refractory esophageal neoplasia in patients who had undergone first line endoscopic eradication therapy (EET). Complete remission of dysplasia (CR-D) and complete remission of intestinal metaplasia (CR-IM) at first follow-up endoscopy, durability of disease reversal, rates of stenosis and adverse events were studied. Patients and methods Eighteen cases were treated. At baseline, nine patients had low-grade dysplasia (LGD), six had high-grade dysplasia (HGD) and three had intramucosal carcinoma (IMC). Median length of dysplastic Barrett’s esophagus (BE) treated was 3 cm. The median number of ablations per patient was 11. Each selected area of visible dysplasia received 10 seconds of ablation. One session of cryoablation was performed per patient. Biopsies were performed at around 3 months post-ablation. Results CR-D was achieved in 78 % and CR-IM in 39 % of patients. There were no device malfunction or adverse events. Stenosis was noted in 11 % of cases. At a median follow up of 19-months, CR-D was maintained in 72 % of patients and CR-IM in 33 %. Conclusions Cryoablation appears to be a viable rescue strategy in patients with refractory neoplasia. It is well tolerated and successful in obtaining CR-D and CR-IM in patients with treatment-refractory BE. Further trials of dosimetry, efficacy and safety in treatment-naïve patients are underway.

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“…74 Sengupta et al reported the use of cryotherapy in a cohort of patients who had failed to achieve eradication of dysplasia despite three RFA sessions. 75 Of 121 patients with dysplasia who underwent RFA, 30 (25%) failed RFA therapy of whom 16 underwent cryotherapy as salvage. CE-N was achieved in 12 (5%) and CE-IM was achieved in 5 (31%) of patients.…”

Section: Endoscopic Therapy For Bementioning

confidence: 99%

Recent advances in Barrett's esophagus

Inadomi

Alastal

Bonavina

et al. 2018

Annals of the New York Academy of Sciences

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Barrett's esophagus (BE) is the only known precursor of esophageal adenocarcinoma, one of the few cancers with increasing incidence in developed countries. The pathogenesis of BE is unclear with regard to either the cellular origin of this metaplastic epithelium or the manner in which malignant transformation occurs, although recent data indicate a possible junctional origin of stem cells for BE. Treatment of BE may be achieved using endoscopic eradication therapy; however, there is a lack of discriminatory tools to identify individuals at sufficient risk for cancer development in whom intervention is warranted. Reduction in gastroesophageal reflux of gastric contents including acid is mandatory to achieve remission from BE after endoscopic ablation, and can be achieved using medical or nonmedical interventions. Research topics of greatest interest include the mechanism of BE development and transformation to cancer, risk stratification methods to identify individuals who may benefit from ablation of BE, optimization of eradication therapy, and surveillance methods to ensure that remission is maintained after eradication is achieved.

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Salvage cryotherapy after failed radiofrequency ablation for Barrett’s esophagus–related dysplasia is safe and effective

Cited by 52 publications

References 16 publications

Feasibility of liquid nitrogen cryotherapy after failed radiofrequency ablation for Barrett's esophagus

Feasibility of liquid nitrogen cryotherapy after failed radiofrequency ablation for Barrett's esophagus

Cryoballoon ablation for treatment of patients with refractory esophageal neoplasia after first line endoscopic eradication therapy

Recent advances in Barrett's esophagus

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