Safety and efficacy of cryo-ablation on Barrett esophagus: a systematic review and meta-analysis

Aims Barrett esophagus (BE) represents a pre-malignant condition of the esophagus and current guidelines favor endoscopic eradication therapy (EET). After endoscopic resection for visible neoplastic lesions, field ablation of the residual BE is advised to mitigate the risk of metachronous neoplasia. Cryoablation was introduced as an endoscopic ablative option for BE during the last decade with growing data on outcomes and interest in potential lower adverse events that established ablative techniques. This systematic review and meta-analysis aimed to summarize the existing data regarding safety and efficacy of Cryoablation on BE treatment.

Methods A systematic literature search in Medline, Cochrane and Scopus databases was performed until November 2023 for full papers. Safety was considered as the primary outcome, interpreted as the overall rate of procedure related adverse events. Secondary outcomes included post-Cryoablation stricture development, and the complete eradication rates of intestinal metaplasia (CEIM) and dysplasia (CED). In case of heterogeneity, a sub-analysis based on the used device was performed for the primary outcome. Random effects model was used and the results were reported as percentages for pooled rates with 95% Confidence Intervals (95% CIs).

Results Ten full-paper studies (471 patients; 80.3% men; mean age 62.2-69) were eligible for analysis. The mean BE length, based on Prague classification, was C0-2M2-5. Regarding the primary outcome, the overall adverse events rate was 19.7% (95% CI: 14-25.4; I²=60.66%), although they were mild in the vast majority. Strictures warranting treatment were developed in 30 patients, representing 4.4% (95% CI: 1.8-7.1; I²=61.18%). Four studies provided results on CED, yielding a rate of 94.6% (95% CI: 90.1-99.1; I²=61.06%) whereas CEIM was assessed in six studies, reporting a rate of 90.1% (95% CI: 82.3-97.9; I²=87.92%). Given the high heterogeneity in all outcomes, a sub-analysis including studies on focal Cryoablation was performed, revealing a similar rate of adverse events [16.5% (95% CI: 11.1-21.8)] with lower heterogeneity and non-significant heterogeneity (I²=47.7%).

Conclusions Cryoablation is a safe procedure with initial data showing a potentially low rate of esophageal strictures and comparable rates of dysplasia and BE eradication when compared to other ablative technologies. High-quality prospective studies including comparisons with established ablation techniques are warranted.

 

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Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
15 April 2024