Cryoablation of Barrett's esophagus: a pilot study

• Published in: Gastrointestinal endoscopy Vol. 62; no. 6; pp. 842 - 848
• Main Authors: Johnston, Mark H., MD, Eastone, John A., MD, Horwhat, J.D., MD, Cartledge, Jennifer, BS, Mathews, Janice S., CGRN, Foggy, Jacinda R.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.12.2005; Elsevier
• Subjects: 2-Pyridinylmethylsulfinylbenzimidazoles; Aged; Anti-Ulcer Agents - therapeutic use; Barrett Esophagus - drug therapy; Barrett Esophagus - pathology; Barrett Esophagus - surgery; Benzimidazoles - therapeutic use; Biological and medical sciences; Cryosurgery; Digestive system. Abdomen; Endoscopy; Esophagus; Esophagus - pathology; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Omeprazole - analogs & derivatives; Omeprazole - therapeutic use; Other diseases. Semiology; Pilot Projects; Rabeprazole; Digestive diseases; Barrett esophagus; Premalignant lesion; Esophageal disease
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2005.05.008

Background Numerous ablative modalities have demonstrated varying degrees of efficacy in the eradication of Barrett's esophagus (BE). However, they are associated with either high cost, patient discomfort, complications, tedious application, residual underlying BE, or some combination of the above. The aim of this study was to evaluate the safety and the efficacy of a new cryogenic device by using liquid nitrogen sprayed through an open tipped cryogenic catheter placed through the accessory channel of an upper endoscope. Methods A prospective, single center study was performed on patients with a long-standing history of BE followed in a Barrett's registry. Patients with degrees of dysplasia ranging from none to multifocal high-grade dysplasia were treated. All patients were treated with 40 mg rabeprazole 3 times per day during the treatment period. Elimination of acid reflux was confirmed via 24-hour esophageal pH studies. Cryo was applied hemicircumferentially to 4-cm-long segments at monthly intervals, until the entire segment of BE was eliminated. Results Eleven patients were treated. There was reversal of BE in all patients. In 9 of 11 (78%) patients who completed the protocol, there was complete endoscopic and histologic reversal of BE. There was no subsquamous specialized intestinal metaplasia at the 6-month follow-up. No complications occurred. Conclusions Based on preliminary results low pressure, spray, cryoablation of BE under direct endoscopic visualization is safe and easy to perform. Its relative lack of patient discomfort and its simplicity and demonstrated efficacy make it a modality that should be further explored in the ablation of GI mucosal lesions such as BE and perhaps early esophageal cancer.