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CC BY-NC-ND 4.0 · Endoscopy 2023; 55(10): 889-897
DOI: 10.1055/a-2105-2177
Original article

A prospective multicenter study to evaluate the impact of cryotherapy on dysphagia and quality of life in patients with inoperable esophageal cancer

Toufic Kachaamy
1   Department of Gastroenterology, City of Hope Phoenix, Goodyear, Arizona, United States
,
Neil Sharma
2   Division of Interventional Oncology and Surgical Endoscopy, Parkview Cancer Institute, Fort Wayne, Indiana, United States
,
Tilak Shah
3   Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic, Weston, Florida, United States
4   Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, Arizona, United States
,
Sonmoon Mohapatra
5   Department of Gastroenterology and Nutrition, City of Hope Chicago, Zion, Illinois, United States
,
Kimberly Pollard
6   Division of Gastroenterology and Hepatology, Central Virginia VA Healthcare System, Richmond, Virginia, United States
,
Christina Zelt
2   Division of Interventional Oncology and Surgical Endoscopy, Parkview Cancer Institute, Fort Wayne, Indiana, United States
,
Elaine Jewett
1   Department of Gastroenterology, City of Hope Phoenix, Goodyear, Arizona, United States
,
Rigoberto Garcia
1   Department of Gastroenterology, City of Hope Phoenix, Goodyear, Arizona, United States
,
Rachel Munsey
4   Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, Arizona, United States
,
Saurabh Gupta
2   Division of Interventional Oncology and Surgical Endoscopy, Parkview Cancer Institute, Fort Wayne, Indiana, United States
,
Mariajose Rojas-DeLeon
2   Division of Interventional Oncology and Surgical Endoscopy, Parkview Cancer Institute, Fort Wayne, Indiana, United States
,
Digant Gupta
6   Division of Gastroenterology and Hepatology, Central Virginia VA Healthcare System, Richmond, Virginia, United States
,
Vivek Kaul
7   Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, New York, United States
,
Rahul Pannala
5   Department of Gastroenterology and Nutrition, City of Hope Chicago, Zion, Illinois, United States
,
Pankaj Vashi
6   Division of Gastroenterology and Hepatology, Central Virginia VA Healthcare System, Richmond, Virginia, United States
› Author AffiliationsTrial Registration: ClinicalTrials.gov Registration number (trial ID): NCT03285035 Type of study: Prospective
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Author commentary on Toufic Kachaamy et al.Endoscopy 2023; 55(10): v31-v31
DOI: 10.1055/a-2119-0468

Abstract

Background Dysphagia palliation in inoperable esophageal cancer continues to be a challenge. Self-expandable metal stents have been the mainstay of endoscopic palliation but have a significant risk of adverse events (AEs). Liquid nitrogen spray cryotherapy is an established modality that can be used with systemic therapy. This study reports the outcomes of cryotherapy, including dysphagia and quality of life (QoL), in patients receiving systemic therapy.

Methods This was a prospective multicenter cohort study of adults with inoperable esophageal cancer who underwent cryotherapy. QoL and dysphagia scores before and after cryotherapy were compared.

Results 55 patients received 175 cryotherapy procedures. After a mean of 3.2 cryotherapy sessions, mean QoL improved from 34.9 at baseline to 29.0 at last follow-up (P < 0.001) and mean dysphagia improved from 1.9 to 1.3 (P = 0.004). Patients receiving more intensive cryotherapy (≥ 2 treatments within 3 weeks) showed a significantly greater improvement in dysphagia compared with those not receiving intensive therapy (1.2 vs. 0.2 points; P = 0.003). Overall, 13 patients (23.6 %) received another intervention (1 botulinum toxin injection, 2 stent, 3 radiation, 7 dilation) for dysphagia palliation. Within the 30-day post-procedure period, there were three non-cryotherapy-related grade ≥ 3 AEs (all deaths). The median overall survival was 16.4 months.

Conclusion In patients with inoperable esophageal cancer receiving concurrent systemic therapy, adding liquid nitrogen spray cryotherapy was safe and associated with improvement in dysphagia and QoL without causing reflux. More intensive treatment showed a greater improvement in dysphagia and should be considered as the preferred approach.



Publication History

Received: 18 December 2022

Accepted after revision: 25 May 2023

Accepted Manuscript online:
02 June 2023

Article published online:
25 July 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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