Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2010 Apr;71(4):680-5.
doi: 10.1016/j.gie.2010.01.018.

Safety and efficacy of endoscopic spray cryotherapy for Barrett's esophagus with high-grade dysplasia

Nicholas J Shaheen  1 , Bruce D Greenwald, Anne F Peery, John A Dumot, Norman S Nishioka, Herbert C Wolfsen, J Steven Burdick, Julian A Abrams, Kenneth K Wang, Damien Mallat, Mark H Johnston, Alvin M Zfass, Jenny O Smith, James S Barthel, Charles J Lightdale
Affiliations
Multicenter Study

Safety and efficacy of endoscopic spray cryotherapy for Barrett's esophagus with high-grade dysplasia

Nicholas J Shaheen et al. Gastrointest Endosc. 2010 Apr.

Abstract

Background: Endoscopic ablation to treat Barrett's esophagus (BE) with high-grade dysplasia (HGD) is associated with a decreased incidence of esophageal adenocarcinoma. Endoscopic spray cryotherapy (CRYO) demonstrates promising preliminary data.

Objective: To assess the safety and efficacy of CRYO in BE with HGD.

Design: Multicenter, retrospective cohort study.

Setting: Nine academic and community centers; treatment period, 2007 to 2009.

Patients: Subjects with HGD confirmed by 2 pathologists. Previous EMR was allowed if residual HGD remained.

Interventions: CRYO with follow-up biopsies.

Main outcome measurements: Complete eradication of HGD with persistent low-grade dysplasia, complete eradication of all dysplasia with persistent nondysplastic intestinal metaplasia, and complete eradication of all intestinal metaplasia.

Results: Ninety-eight subjects (mean age 65.4 years, 83% male) with BE and HGD (mean length 5.3 cm) underwent 333 treatments (mean 3.4 treatments per subject). There were no esophageal perforations. Strictures developed in 3 subjects. Two subjects reported severe chest pain managed with oral narcotics. One subject was hospitalized for bright red blood per rectum. Sixty subjects had completed all planned CRYO treatments and were included in the efficacy analysis. Fifty-eight subjects (97%) had complete eradication of HGD, 52 (87%) had complete eradication of all dysplasia with persistent nondysplastic intestinal metaplasia, and 34 (57%) had complete eradication of all intestinal metaplasia. Subsquamous BE was found in 2 subjects (3%).

Limitations: Nonrandomized, retrospective study with no control group, short follow-up (10.5 months), lack of centralized pathology, and use of surrogate outcome for decreased cancer risk.

Conclusions: CRYO is a safe and well-tolerated therapy for BE and HGD. Short-term results suggest that CRYO is highly effective in eradicating HGD.

PubMed Disclaimer

Figures

Figure 1
Figure 1
A, Dual-channel decompression tube in place, as seen through the endoscope with a friction-fit cap before administration of liquid nitrogen. B, White frost demonstrated in the distal esophagus, signaling the freeze time.
Figure 2
Figure 2
Efficacy cohort analysis: percentage achieving complete eradication.
Figure 3
Figure 3
Subsquamous intestinal metaplasia.
See this image and copyright information in PMC

Comment in

References

    1. Shaheen NJ, Richter JE. Barrett’s oesophagus. Lancet. 2009;373:850–61. - PubMed
    1. Spechler SJ. Clinical practice. Barrett’s esophagus. N Engl J Med. 2002;346:836–42. - PubMed
    1. O’Connor JB, Falk GW, Richter JE. The incidence of adenocarcinoma and dysplasia in Barrett’s esophagus: report on the Cleveland Clinic Barrett’s Esophagus Registry. Am J Gastroenterol. 1999;94:2037–42. - PubMed
    1. Drewitz DJ, Sampliner RE, Garewal HS. The incidence of adenocarcinoma in Barrett’s esophagus: a prospective study of 170 patients followed 4.8 years. Am J Gastroenterol. 1997;92:212–5. - PubMed
    1. Shaheen NJ, Sharma P, Overholt BF, et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med. 2009;360:2277–88. - PubMed

Publication types

MeSH terms