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Cryotherapy and Radiofrequency Ablation for Eradication of Barrett’s Esophagus with Dysplasia or Intramucosal Cancer

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Abstract

Background and Aims

Endoscopic ablation therapy has become the mainstay of treatment of Barrett’s associated dysplasia and intramucosal cancer (IMC). The widely available techniques for ablation are radiofrequency ablation (RFA) and cryotherapy. Our aim was to compare eradication rates of metaplasia and dysplasia with both these modalities.

Patients and Methods

Retrospective review of prospectively collected database of patients who underwent endoscopic therapy for Barrett’s dysplasia or IMC from 2006 to 2011 was performed. Demographic features, comorbidities, and endoscopic data including length of Barrett’s segment, hiatal hernia size, interventions during the endoscopy and histological results were reviewed.

Results

Among 154 patients included, 73 patients were in the RFA and 81 patients were in the cryotherapy group. There was complete eradication of intestinal metaplasia (CE-IM) in 81 (52.6%), complete eradication of dysplasia (CE-D) in 133 (86.4%), and persistent dysplasia or cancer in 19 patients (12.3%). Compared to RFA, cryotherapy patients were found to be older and less likely to have undergone endoscopic mucosal resection. On multivariate analysis, patients who underwent RFA had a threefold higher odds of having CE-IM than those who underwent cryotherapy (odds ratio [OR] 2.9, 95% confidence interval [CI] 1.4–6.0, p = 0.004), but CE-D were similar between the two groups (OR 1.7, 95% CI 0.66–4.3, p = 0.28).

Conclusions

Endoscopic therapy is highly effective in eradication of Barrett’s associated neoplasia. Patients who underwent cryotherapy were equally likely to achieve CE-D but not CE-IM than patients who underwent RFA. Patient characteristics and preferences may effect choice of treatment selection and outcomes.

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Authors and Affiliations

  1. Center of Excellence for Barrett’s Esophagus, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, 44195, USA

    Prashanthi N. Thota, Zubin Arora, Tanmayee Benjamin, Sunguk Jang & John J. Vargo

  2. Department of Gastroenterology and Hepatology, Case Western Reserve University, Cleveland, OH, 44106, USA

    John A. Dumot

  3. Department of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA

    Gary Falk

  4. Department of Pathology, Cleveland Clinic, Cleveland, OH, 44195, USA

    John Goldblum

  5. Department of Biostatistics, Cleveland Clinic, Cleveland, OH, 44195, USA

    Rocio Lopez

  6. Department of Gastroenterology and Hepatology, A30, Center of Excellence for Barrett’s Esophagus, Cleveland Clinic, Cleveland, OH, 44195, USA

    Prashanthi N. Thota

Authors
  1. Prashanthi N. Thota
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  2. Zubin Arora
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  3. John A. Dumot
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  4. Gary Falk
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  5. Tanmayee Benjamin
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  7. Sunguk Jang
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  8. Rocio Lopez
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  9. John J. Vargo
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Corresponding author

Correspondence to Prashanthi N. Thota.

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Thota, P.N., Arora, Z., Dumot, J.A. et al. Cryotherapy and Radiofrequency Ablation for Eradication of Barrett’s Esophagus with Dysplasia or Intramucosal Cancer. Dig Dis Sci 63, 1311–1319 (2018). https://doi.org/10.1007/s10620-018-5009-4

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  • DOI: https://doi.org/10.1007/s10620-018-5009-4

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