Safety and efficacy of endoscopic spray cryotherapy for Barrett's dysplasia: results of the National Cryospray Registry

• Published in: Diseases of the esophagus Vol. 29; no. 3; pp. 241 - 247
• Main Authors: Ghorbani, S., Tsai, F. C., Greenwald, B. D., Jang, S., Dumot, J. A., McKinley, M. J., Shaheen, N. J., Habr, F., Coyle, W. J.
• Format: Journal Article
• Language: English
• Published: United States 01.04.2016
• Subjects: Aged; Aged, 80 and over; Barrett esophagus; Barrett Esophagus - surgery; Catheter Ablation - methods; cryotherapy; Cryotherapy - methods; endoscopy; esophageal neoplasm; Esophagoscopy - methods; Female; human; Humans; Male; Middle Aged; Nitrogen - administration & dosage; Nitrogen - chemistry; Prospective Studies; Registries; Treatment Outcome; endoscopy; Barrett esophagus; cryotherapy; esophageal neoplasm; human
• ISSN: 1120-8694; 1442-2050; 1442-2050
• DOI: 10.1111/dote.12330

Summary Retrospective series have shown the efficacy of endoscopic spray cryotherapy in eradicating high‐grade dysplasia (HGD) in Barrett's esophagus (BE); however, prospective data are lacking, and efficacy for low‐grade dysplasia (LGD) is unclear. The aim of this study was to assess the efficacy and safety of spray cryotherapy in patients with LGD or HGD. A multicenter, prospective open‐label registry enrolled patients with dysplastic BE. Spray cryotherapy was performed every 2–3 months until there was no endoscopic evidence of BE and no histological evidence of dysplasia, followed by surveillance endoscopies up to 2 years. Primary outcome measures were complete eradication of dysplasia (CE‐D) and complete eradication of all intestinal metaplasia (CE‐IM). Ninety‐six subjects with Barrett's dysplasia (67% HGD; 65% long‐segment BE; mean length 4.5 cm) underwent 321 treatments (mean 3.3 per subject). Mean age was 67 years, 83% were male. Eighty patients (83%) completed treatment with follow‐up endoscopy (mean duration 21 months). In patients with LGD, rate of CE‐D was 91% (21/23) and rate of CE‐IM was 61% (14/23). In HGD, CE‐D rate was 81% (46/57) and CE‐IM was 65% (37/57). In patients with short‐segment BE (SSBE) with any dysplasia, CE‐D was achieved in 97% (30/31) and CE‐IM in 77% (24/31). There were no esophageal perforations or related deaths. One subject developed a stricture, which did not require dilation. One patient was hospitalized for bleeding in the setting of non‐steroidal anti‐inflammatory drug use. In the largest prospective cohort to date, data suggest endoscopic spray cryotherapy is a safe and effective modality for eradication of BE with LGD or HGD, particularly with SSBE.