Salvage cryotherapy after failed radiofrequency ablation for Barrett's esophagus-related dysplasia is safe and effective.

Abstract

BACKGROUND:

Radiofrequency ablation (RFA) is an effective treatment for Barrett's esophagus (BE) dysplasia. For patients with dysplasia refractory to RFA, data are limited regarding efficacy of endoscopic therapy.

OBJECTIVE:

To assess the efficacy and safety of cryotherapy in patients with BE dysplasia who failed RFA.

DESIGN:

Single-center, retrospective, cohort study.

SETTING:

Tertiary-care center between 2006 and 2013.

PATIENTS:

Patients with BE and low-grade dysplasia (LGD), high-grade dysplasia (HGD), or intramucosal carcinoma (IMC) were referred for RFA every 2 to 3 months. Response was determined by complete eradication of dysplasia (CE-D).

INTERVENTIONS:

Patients without CE-D or those with recurrent dysplasia after initial eradication were offered cryotherapy.

MAIN OUTCOME MEASUREMENTS:

Eradication of dysplasia and/or cancer. Secondary outcome, eradication of intestinal metaplasia.

RESULTS:

A total of 121 patients underwent RFA for BE dysplasia (55% HGD, 26% LGD, 17% IMC, 2% indefinite dysplasia). After a median of 3 RFA sessions, 75% (n = 91) had CE-D. Patients without CE-D were more likely to have a longer BE length (7 cm vs 4 cm; P = .004) and a hiatal hernia (83% vs 55%; P = .005). Sixteen patients (14 with failed CE-D and 2 with recurrent dysplasia) were offered cryotherapy and had endoscopic follow-up. Seven (57%) had HGD before cryotherapy (6 with LGD, 2 with IMC, and 1 with indefinite dysplasia). After cryotherapy, 12 (75%) had CE-D, and 5 (31%) had eradication of intestinal metaplasia. Of patients with IMC, 100% had CE-D. Three patients developed strictures that responded to dilation.

LIMITATIONS:

Single center, retrospective nature of study.

CONCLUSION:

For patients with refractory dysplasia or recurrent dysplasia after RFA, salvage cryotherapy is a safe and effective endoscopic therapy.

• Authors: Neil Sengupta, Gyanprakash A Ketwaroo, Daniel M Bak, Vikram Kedar, Ram Chuttani, Tyler M Berzin, Mandeep S Sawhney, Douglas K Pleskow
• Journal: Gastrointestinal endoscopy (Gastrointest Endosc) Vol. 82 Issue 3 Pg. 443-8 (Sep 2015) ISSN: 1097-6779 [Electronic] United States
• PMID: 25887715 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Topics

• Adenocarcinoma (pathology, surgery)
• Adenocarcinoma in Situ (pathology, surgery)
• Aged
• Barrett Esophagus (pathology, surgery)
• Catheter Ablation
• Cohort Studies
• Cryosurgery (methods)
• Esophageal Neoplasms (pathology, surgery)
• Esophagoscopy (methods)
• Female
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Salvage Therapy (methods)
• Treatment Failure
• Treatment Outcome