Efficacy of the CryoBalloon Focal Ablation System for the eradication of dysplastic Barrett’s esophagus islands

Abstract

Background and study aim Cryoablation can be used for the treatment of Barrett’s esophagus (BE). A recent dosimetry study, using the CryoBalloon Focal Ablation System (CryoBalloon), demonstrated that 10-second ablations result in complete eradication of BE. However, the efficacy of 10-second ablation in a larger cohort of patients has not been investigated, nor has the potential of precise targeting of specific areas. The aim of the study was to assess the efficacy and performance (i. e. targeting of BE islands) of a 10-second cryoablation using the CryoBalloon.

Results A total of 30 patients were enrolled (worst pathology: low grade dysplasia in 14 [47 %], high grade dysplasia in 7 [23 %], early adenocarcinoma in 9 [30 %]). Of the 47 BE islands, 44 (94 %) were adequately targeted. Complete eradication of intestinal metaplasia and dysplasia was observed in 100 % of the completely ablated areas. No stenoses were observed.

Conclusion Cryoablation of BE islands using the CryoBalloon is effective. BE islands were effectively targeted.

• References

• 1 Buttar NS, Wang KK, Sebo TJ. et al. Extent of high-grade dysplasia in Barrett’s esophagus correlates with risk of adenocarcinoma. Gastroenterology 2001; 120: 1630-1639
• 2 Curvers WL, ten Kate FJ, Krishnadath KK. et al. Low-grade dysplasia in Barrett’s esophagus: overdiagnosed and underestimated. Am J Gastroenterol 2010; 105: 1523-1530
• 3 Phoa KN, van Vilsteren FG, Weusten BL. et al. Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia. JAMA 2014; 311: 1209
• 4 Phoa KN, Pouw RE, Bisschops R. et al. Multimodality endoscopic eradication for neoplastic Barrett oesophagus: results of an European multicentre study (EURO-II). Gut 2015; 65: 555-562
• 5 Shaheen NJ, Sharma P, Overholt BF. et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med 2009; 360: 2277-2288
• 6 Schölvinck DW, Künzli HT, Kestens C. et al. Treatment of Barrett’s esophagus with a novel focal cryoablation device: a safety and feasibility study. Endoscopy 2015; 47: 1106-1112
• 7 Sharma P, Dent J, Armstrong D. et al. The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria. Gastroenterology 2006; 131: 1392-1399
• 8 Gosain S, Mercer K, Twaddell WS. et al. Liquid nitrogen spray cryotherapy in Barrett’s esophagus with high-grade dysplasia: long-term results. Gastrointest Endosc 2013; 78: 260-265
• 9 Dumot JA, Vargo JJ, Falk GW. et al. An open-label, prospective trial of cryospray ablation for Barrett’s esophagus high-grade dysplasia and early esophageal cancer in high-risk patients. Gastrointest Endosc 2009; 70: 635-644
• 10 Canto M, Shin EJ, Khashab M. et al. Multifocal nitrous oxide cryoballoon ablation with or without endoscopic mucosal resection (EMR) for treatment of neoplastic Barrett’s esophagus (BE): preliminary results of a prospective clinical trial in treatment-naive and previously ablated patients. Gastrointest Endosc 2016; 83: AB159
• 11 Phoa KN, Pouw RE, van Vilsteren FG. et al. Remission of Barrett’s esophagus with early neoplasia 5 years after radiofrequency ablation with endoscopic resection: a Netherlands cohort study. Gastroenterology 2013; 145: 96-104
• 12 Shaheen NJ, Overholt BF, Sampliner RE. et al. Durability of radiofrequency ablation in Barrett’s esophagus with dysplasia. Gastroenterology 2011; 141: 460-448
• 13 Weusten BL, Bergman JJ. Cryoablation for managing Barrett’s esophagus refractory to radiofrequency ablation?Don’t embrace the cold too soon!. Gastrointest Endosc 2015; 82: 449-451
• 14 Van Vilsteren FG, Pouw RE, Seewald S. et al. Stepwise radical endoscopic resection versus radiofrequency ablation for Barrett’s oesophagus with high-grade dysplasia or early cancer: a multicentre randomised trial. Gut 2011; 60: 765-773
• 15 Pouw RE, Wirths K, Eisendrath P. et al. Efficacy of radiofrequency ablation combined with endoscopic resection for barrett’s esophagus with early neoplasia. Clin Gastroenterol Hepatol 2010; 8: 23-29