Mohammad Alshelleh, MD1, Matthew J. McKinley, MD, FACG2, Kara L. Raphael, MD3, Arvind J. Trindade, MD4; 1Zucker School of Medicine at Hofstra / Northwell Health System, Farmington, CT; 2ProHEALTH Care, Lake Success, NY; 3Zucker School of Medicine at Hofstra / Northwell, Manhasset, NY; 4Northwell Health System, New Hyde Park, NY
Introduction: Cryotherapy is often used for dysplastic Barrett’s esophagus (BE) refractory to radiofrequency ablation (RFA).There are 2 systems for endoscopic cryotherapy that are available for clinical use in the gastrointestinal (GI) tract. The spray cryotehrapy system that delivers liquid nitrogen through a low-pressure, non-contact, 213 cm long, 7F spray catheter and results in flash freezing the mucosa to -196 °C, while the other one uses a cryogenic balloon catheter that requires direct contact with the target tissue that delivers cryogenic nitrous oxide (-85 °C) into an inflated balloon. There has been no studies directly comparing the two forms of cryotherapy. The aim of this study was to compare the two modalities for primary therapy in BE with dysplasia. Methods: This is a retrospective study from a tertiary care center from 2015 to 2019. Patients were included if: 1) they had confirmed BE with dysplasia on histology 2) underwent cryotherapy every 3 months for a minimum of 2 sessions 2) were treatment naïve to ablation prior to cryotherapy 3) had at least 12 months follow up or achieved complete eradication of intestinal metaplasia (CE-IM) with at least one subsequent endoscopic biopsy conformation. Primary outcome measures stratified by histology were: (a) complete eradication of dysplasia (CE-D) and CE-IM at 18 months. The secondary outcome was measurement of adverse events. Results: A total of 71 patients were analyzed. 46 underwent cryoballoon ablation and 25 underwent cryospray therapy. Patient characteristics and are in Table 1. CE-D and CE-IM were achieved in 95.6% and 84.75% in the cryoballoon group vs. 96% and 80% in the cryospray group respectively. When stratified by baseline histology there was no significant statistical difference in CE-D or CE-IM between the groups (Table 2). There was no statistical difference for grades of dysplasia between groups (Table 2). Similarly there was no significant difference patients developed strictures requiring endoscopic dilation between both groups. Discussion: In this study we show that cryoballon and cryopsray therapy can have the same efficacy as RFA therapy when looking at CE-IM and CE-D rates. This study is important as cryotherapy has a more favorable post-procedural pain profile vs RFA. In conclusion, our study showed that both cryotherapy modalities are equally effective in eradication of dysplastic Barrett’s. Baseline histology is not a predictor of cryotherapy response. Prospective studies are needed to conform this data.
Table 1. Patient baseline characteristics and cryotherapy outcomes
Table 2. Patient baseline characteristics and cryotherapy outcomes stratified according to grade of dysplasia.
Disclosures: Mohammad Alshelleh indicated no relevant financial relationships. Matthew McKinley indicated no relevant financial relationships. Kara Raphael indicated no relevant financial relationships. Arvind Trindade: Olympus America – Consultant. Pentax Medical – Consultant.