Advertisement

Digestive Diseases and Sciences

, Volume 63, Issue 5, pp 1311–1319 | Cite as

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

  • Prashanthi N. Thota
  • Zubin Arora
  • John A. Dumot
  • Gary Falk
  • Tanmayee Benjamin
  • John Goldblum
  • Sunguk Jang
  • Rocio Lopez
  • John J. Vargo
Original Article

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.

Keywords

Barrett’s esophagus Dysplasia Endoscopy Ablation Cryotherapy 

Notes

Compliance with ethical standards

Conflict of interest

All the authors declare that they have no conflict of interest.

References

  1. 1.
    Arora Z, Garber A, Thota PN. Risk factors for Barrett’s esophagus. J Dig Dis. 2016;17:215–221.CrossRefPubMedGoogle Scholar
  2. 2.
    Schlemper RJ, Riddell RH, Kato Y, et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut. 2000;47:251–255.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Shaheen NJ, Falk GW, Iyer PG, et al. ACG clinical guideline: diagnosis and management of Barrett’s esophagus. Am J Gastroenterol. 2015;111:30–50.CrossRefPubMedGoogle Scholar
  4. 4.
    Haidry R, Lovat L, Sharma P. Radiofrequency ablation for Barrett’s dysplasia: past, present and the future? Curr Gastroenterol Rep. 2015;17:13.CrossRefPubMedGoogle Scholar
  5. 5.
    Haidry R, Lovat L. Long-term durability of radiofrequency ablation for Barrett’s-related neoplasia. Curr Opin Gastroenterol. 2015;31:316–320.CrossRefPubMedGoogle Scholar
  6. 6.
    Evans JA, Early DS, Fukami N, et al. The role of endoscopy in Barrett’s esophagus and other premalignant conditions of the esophagus. Gastrointest Endosc. 2012;76:1087–1094.CrossRefPubMedGoogle Scholar
  7. 7.
    Ghorbani S, Tsai FC, Greenwald BD, et al. Safety and efficacy of endoscopic spray cryotherapy for Barrett’s dysplasia: results of the National Cryospray Registry. Dis Esophagus. 2016;29:241–247.CrossRefPubMedGoogle Scholar
  8. 8.
    Greenwald BD, Dumot JA, Horwhat JD, et al. Safety, tolerability, and efficacy of endoscopic low-pressure liquid nitrogen spray cryotherapy in the esophagus. Dis Esophagus. 2010;23:13–19.CrossRefPubMedGoogle Scholar
  9. 9.
    Shaheen NJ, Greenwald BD, Peery AF, et al. Safety and efficacy of endoscopic spray cryotherapy for Barrett’s esophagus with high-grade dysplasia. Gastrointest Endosc. 2010;71:680–685.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Gupta M, Iyer PG, Lutzke L, et al. Recurrence of esophageal intestinal metaplasia after endoscopic mucosal resection and radiofrequency ablation of Barrett’s esophagus: results from a US Multicenter Consortium. Gastroenterology. 2013;145:79–86.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Cotton CC, Wolf WA, Pasricha S, et al. Recurrent intestinal metaplasia after radiofrequency ablation for Barrett’s esophagus: endoscopic findings and anatomic location. Gastrointest Endosc. 2015;81:1362–1369.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Halsey KD, Chang JW, Waldt A, et al. Recurrent disease following endoscopic ablation of Barrett’s high-grade dysplasia with spray cryotherapy. Endoscopy. 2011;43:844–848.CrossRefPubMedGoogle Scholar
  13. 13.
    Desai M, Saligram S, Gupta N, et al. Efficacy and safety outcomes of multimodal endoscopic eradication therapy in Barrett’s esophagus-related neoplasia: a systematic reviewand pooled analysis. Gastrointest Endosc. 2017;85:482–495.CrossRefPubMedGoogle Scholar
  14. 14.
    Orman ES, Li N, Shaheen NJ. Efficacy and durability of radiofrequency ablation for Barrett’s Esophagus: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2013;11:1245–1255.CrossRefPubMedGoogle Scholar
  15. 15.
    Haidry RJ, Butt MA, Dunn JM, UK RFA Registry, et al. Improvement over time in outcomes for patients undergoing endoscopic therapy for Barrett’s oesophagus-related neoplasia: 6-year experience from the first 500 patients treated in the UK patient registry. Gut. 2015;64:1192–1199.CrossRefPubMedGoogle Scholar
  16. 16.
    Spechler SJ, Sharma P, Souza RF, et al. American Gastroenterological Association medical position statement on the management of Barrett’s esophagus. Gastroenterology. 2011;140:1084–1091.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Prashanthi N. Thota
    • 1
    • 6
  • Zubin Arora
    • 1
  • John A. Dumot
    • 2
  • Gary Falk
    • 3
  • Tanmayee Benjamin
    • 1
  • John Goldblum
    • 4
  • Sunguk Jang
    • 1
  • Rocio Lopez
    • 5
  • John J. Vargo
    • 1
  1. 1.Center of Excellence for Barrett’s Esophagus, Digestive Disease InstituteCleveland ClinicClevelandUSA
  2. 2.Department of Gastroenterology and HepatologyCase Western Reserve UniversityClevelandUSA
  3. 3.Department of GastroenterologyHospital of the University of PennsylvaniaPhiladelphiaUSA
  4. 4.Department of PathologyCleveland ClinicClevelandUSA
  5. 5.Department of BiostatisticsCleveland ClinicClevelandUSA
  6. 6.Department of Gastroenterology and Hepatology, A30, Center of Excellence for Barrett’s EsophagusCleveland ClinicClevelandUSA

Personalised recommendations