Canto MI, et al. - A scrutiny was performed of the safety and efficacy of cryoballoon focal ablation system (CbFAS) for the complete eradication of neoplastic Barrett's esophagus (BE). During this study, BE patients with confirmed neoplasia [low-grade dysplasia (LGD), high-grade dysplasia (HGD), and/or intramucosal adenocarcinoma (ImCA)], at least 1 cm of BE, with or without prior ablation, were treated with a dose 10 seconds of spray per site. It was observed that complete eradication of all dysplasia (CE-D) rate was considerably lower (67%) in those with ultra-long BE compared with those with <8 cm. Yielded data demonstrated that multifocal nitrous oxide cryotherapy using CbFAS was a promising, highly effective, and safe endoscopic therapy for primary or rescue therapy of BE-associated neoplasia and intestinal metaplasia.

Methods

• This prospective clinical trial included consecutive BE patients with confirmed neoplasia (low-grade dysplasia LGD, high-grade dysplasia HGD, and/or intramucosal adenocarcinoma ImCA), at least 1 cm of BE, with or without prior ablation, who were treated with a dose 10 seconds of spray per site.
• During this study, EMR was carried out for nodular lesions.
• Repetition of treatments were done every 10 to 12 weeks until complete eradication, with a maximum of 5.
• Complete eradication of all dysplasia (CE-D) and intestinal metaplasia (CE-IM) at 1 year (intention-to-treat analysis) served as the primary outcomes.

Results

• A total of 41 evaluable patients (22 treatment-naïve, 19 previously ablated) with LGD (n=13), HGD (n=23) or ImCA (n=5) were recruited.
• The median procedure time was discovered to be 30 minutes.
• The median number of ablation procedures for CE-IM was 3 (IQ range 2-4).
• As per the findings, overall 1-year CE-D and CE-IM rates were 95% and 88%, respectively.
• A markedly lower CE-D rate was found (67%) in those with ultra-long BE compared with those with <8 cm (100%, p=0.02).
• Median pain scores were revealed to be zero at day 1.
• The development of mild dysphagia from stenoses requiring dilation was reported in 4 patients (9.7%).
• Yielded data depicted that 1 patient on aspirin developed upper GI bleeding, not requiring therapy.