Safety and efficacy of carbon dioxide cryotherapy for treatment of neoplastic Barrett’s esophagus

Marcia Irene Canto; Eun Ji Shin; Mouen A. Khashab; Daniela Molena; Patrick Okolo; Elizabeth Montgomery; Pankaj Pasricha

doi:10.1055/s-0034-1391734

Endoscopy, Table of Contents

Endoscopy 2015; 47(07): 582-591
DOI: 10.1055/s-0034-1391734

Original article

Safety and efficacy of carbon dioxide cryotherapy for treatment of neoplastic Barrett’s esophagus

Marcia Irene Canto

¹Division of Gastroenterology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States

²Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States

,

Eun Ji Shin

¹Division of Gastroenterology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States

,

Mouen A. Khashab

¹Division of Gastroenterology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States

,

Daniela Molena

³Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States

,

Patrick Okolo

¹Division of Gastroenterology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States

,

Elizabeth Montgomery

⁴Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States

,

Pankaj Pasricha

¹Division of Gastroenterology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States

› Author Affiliations

Abstract

Background and study aims: Endoscopic cryotherapy has been used successfully for the ablation of Barrett’s esophagus but outcome data are limited. The aim of this study was to assess the long-term safety and efficacy of carbon dioxide (CO₂) cryotherapy as primary or rescue treatment for Barrett’s esophagus with high grade dysplasia (HGD) or neoplasia.

Patients and methods: This was a retrospective, single-center, nonrandomized study carried out in an academic, tertiary care center and affiliated community hospital. A total of 78 patients with neoplastic Barrett’s esophagus who had not undergone previous ablation (treatment-naïve group) or who had persistent or recurrent neoplasia despite previous treatment (rescue treatment group) were enrolled. Visible Barrett’s lesions, when present, were removed by endoscopic mucosal resection, which was followed by CO₂ cryotherapy until neoplasia had been eradicated, or intervening therapy was necessary, or treatment was considered to have failed. Surveillance biopsies were obtained at standard intervals. Rates of complete response for cancer, HGD, and intestinal metaplasia were calculated. Treatment failure, recurrence, adverse events, progression, and mortality were also recorded.

Results: Between 2006 and 2013, 64 evaluable patients (20 treatment naïve, 44 rescue treatment) were treated and followed up (median time 4.2 years). At 1 year, the overall complete response rates were 77 % for cancer (10/13), 89 % for dysplasia 57/64), 94 % for HGD (60/64; 100 % for treatment naïve, 91 % for rescue treatment), and 55 % for intestinal metaplasia (35/64). Long-term complete response for neoplasia with rescue therapy was 87 % (56/64). Disease-specific mortality was 1/68 (2 %). Treatment failed to eradicate neoplasia in four patients (6 %) (all in the rescue group). Recurrent or new intestinal metaplasia was detected in 20/64 (31 %) after two negative follow-up procedures. Serious adverse events were noted in two patients (3 %). Post-cryotherapy pain occurred in four patients (6 %; only two needed analgesics). No bleeding or new strictures were noted. Buried Barrett’s was detected in 5/68 patients (7 %).

Conclusions: CO₂ cryotherapy was a safe and effective primary curative or rescue therapy for Barrett’s neoplasia.

Full Text

References

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