Endoscopy 2011; 43(5): 379-385
DOI: 10.1055/s-0030-1256334
Original article

© Georg Thieme Verlag KG Stuttgart · New York

A pilot study of endoscopic spray cryotherapy by pressurized carbon dioxide gas for Barrett's esophagus

H.  B.  Xue1 , H.  H.  Tan1 , W.  Z.  Liu1 , X.  Y.  Chen1 , N.  Feng1 , Y.  J.  Gao1 , Y.  Song1 , Y.  J.  Zhao1 , Z.  Z.  Ge1
  • 1Department of Gastroenterology, Shanghai Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China
Further Information

Publication History

submitted 7 June 2010

accepted after revision 27 January 2011

Publication Date:
24 March 2011 (online)

Background and study aims: Endoscopic spray cryoablation is a novel approach for the treatment of Barrett's esophagus. However, few studies have reported its efficacy, especially with the use of carbon dioxide (CO2). The aim of the current study was to evaluate the short term efficacy and complications using CO2 in endoscopic cryoablation of Barrett's esophagus.

Methods: Patients diagnosed with Barrett's esophagus underwent monthly stepwise cryoablation with pressurized CO2 gas, with follow-up esophageal biopsies until complete histological reversal was achieved. Responses were analyzed with an intention-to-treat analysis according to complete response for intestinal metaplasia (CR-IM), which was defined as the elimination of all intestinal metaplasia including specialized intestinal metaplasia (SIM), subsquamous SIM, and dysplasia with intestinal metaplasia in the biopsies under narrow-band imaging (NBI).

Results: In total, 22 patients were enrolled, 20 of whom completed the treatment. Two patients declined further ablation after the first cryotherapy session. A total of 44 sessions were performed; a median of 2 sessions per patient (range 1 – 3 sessions) were needed to complete the ablation of Barrett's esophagus. No severe complications occurred. Follow-up endoscopies were performed in 20 patients (90.9 %). Two patients (9.1 %) were lost to follow-up. Median follow-up was 10 months (range 6 – 18 months). After cryotherapy, 20 patients (90.9 %) reached CR-IM of Barrett's esophagus. Patients underwent a median number of 3 follow-up endoscopies (range 2 – 4) with biopsies. At 6 months, recurrence was evident in three patients (13.6 % of the overall population, 15.0 % of the CR-IM population). One of the three patients developed intestinal metaplasia but no dysplastic change and the other two developed subsquamous SIM.

Conclusions: The pressurized CO2 spray cryotherapy is a relatively effective and safe endoscopic treatment for Barrett's esophagus.

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Z. Z. GeMD 

Department of Gastroenterology
Shanghai Renji Hospital
Shanghai Jiaotong University School of Medicine
Shanghai Institute of Digestive Disease

145 Shan-dong Zhong Rd
Shanghai 200001
China

Fax: +86-21-68383015

Email: zhizhengge@yahoo.com.cn

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