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Outcomes of Radiofrequency Ablation Compared to Liquid Nitrogen Spray Cryotherapy for the Eradication of Dysplasia in Barrett’s Esophagus

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Abstract

Introduction

Current guidelines recommend endoscopic eradication therapy (EET) for Barrett’s esophagus (BE) with dysplasia and intramucosal adenocarcinoma using either radiofrequency ablation (RFA) or liquid nitrogen spray cryotherapy (LNSC). The aims of this multicenter study are to compare the rate and number of treatment sessions of RFA vs. LNSC to achieve CE-D and CE-IM and assess outcomes for those who switched therapy.

Methods

This is a retrospective cohort study of patients with BE undergoing EET. Demographics, baseline variables, endoscopy details, and histology information were abstracted.

Results

One hundred and sixty-two patients were included in this study with 100 patients in the RFA group and 62 patients in the LNSC group. The rate of CE-D and CE-IM did not differ between the RFA group and LNSC group (81% vs. 71.0%, p = 0.14) and (64% vs. 66%, p = 0.78), respectively. The number of sessions to achieve CE-D and CE-IM was higher with LNSC compared to RFA (4.2 vs. 3.2, p = 0.05) and (4.8 vs. 3.5, p = 0.04), respectively. The likelihood of developing recurrent dysplasia was higher among patients who did not achieve CE-IM (12%) compared to those who did achieve CE-IM (4%), p = 0.04. Similar findings were found in those who switched treatment modalities.

Discussion

EET is highly effective in eradication of Barrett’s associated dysplasia and neoplasia. Both RFA and LNSC achieved similar rates of CE-D and CE-IM although LNSC required more sessions. Also, achievement of CE-IM was associated with less recurrence rates of dysplasia.

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Authors and Affiliations

  1. Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University Health System, 1200 E. Broad St, PO Box 980341, Richmond, VA, 23298, USA

    Matthew Fasullo, Tilak Shah, Milan Patel, Pritesh Mutha & George Smallfield

  2. Division of Gastroenterology and Hepatology, Hunter Holmes-McGuire VA Medical Center, Richmond, VA, 23249, USA

    Matthew Fasullo, Tilak Shah, Milan Patel, Pritesh Mutha & Alvin Zfass

  3. Department of Pathology, Hunter Holmes-McGuire VA Medical Center, Richmond, VA, 23249, USA

    Robert Lippman

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  1. Matthew Fasullo
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  2. Tilak Shah
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  3. Milan Patel
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  4. Pritesh Mutha
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  5. Alvin Zfass
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  6. Robert Lippman
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  7. George Smallfield
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Contributions

MF, GS, and TS performed study design; MF and MP collected the data; GS, AZ, PM, and TS done endoscopy; MF and TS performed statistical analysis; MF, GS, and TS prepared the manuscript; MF, TS, MP, AZ, RL, PM, GS reviewed the manuscript.

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Correspondence to Matthew Fasullo.

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Fasullo, M., Shah, T., Patel, M. et al. Outcomes of Radiofrequency Ablation Compared to Liquid Nitrogen Spray Cryotherapy for the Eradication of Dysplasia in Barrett’s Esophagus. Dig Dis Sci 67, 2320–2326 (2022). https://doi.org/10.1007/s10620-021-06991-7

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  • DOI: https://doi.org/10.1007/s10620-021-06991-7

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