LIQUID NITROGEN SPRAY CRYOTHERAPY FOR ERADICATION OF DYSPLASTIC BARRETT'S ESOPHAGUS: RESULTS FROM A MULTICENTER PROSPECTIVE REGISTRY

Swathi Eluri; Cary C Cotton; Vivek Kaul; Matthew McKinley; Douglas Pleskow; Norman Nishioka; Brenda Hoffman; Jose Nieto; Franklin Tsai; Walter Coyle; Shivangi Kothari; Virendra Joshi; John Dumot; Bruce Greenwald; Fadlallah G Habr; Nicholas J Shaheen

doi:10.1016/j.gie.2024.01.023

LIQUID NITROGEN SPRAY CRYOTHERAPY FOR ERADICATION OF DYSPLASTIC BARRETT'S ESOPHAGUS: RESULTS FROM A MULTICENTER PROSPECTIVE REGISTRY

Gastrointest Endosc. 2024 Jan 23:S0016-5107(24)00042-7. doi: 10.1016/j.gie.2024.01.023. Online ahead of print.

Authors

Affiliations

¹ Center for Esophageal Diseases and Swallowing, and; Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, NC;. Electronic address: swathi@med.unc.edu.
² Center for Esophageal Diseases and Swallowing, and; Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, NC.
³ University of Rochester Medical Center, Rochester, NY.
⁴ Hofstra North Shore - LIJ School of Medicine, Hempstead, NY.
⁵ Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA.
⁶ Gastroenterology, Massachusetts General Hospital, Boston, MA.
⁷ Medical University of South Carolina, Charleston, SC.
⁸ Borland Groover Clinic, Jacksonville, FL.
⁹ Scripps Health, La Jolla, CA.
¹⁰ Louisana State University Medical Center, Baton Rouge, LA.
¹¹ University Hospitals Cleveland Medical Center, Cleveland, OH.
¹² University of Maryland School of Medicine, Baltimore, MD.
¹³ Rhode Island Hospital, Providence, RI.

PMID: 38272279
DOI: 10.1016/j.gie.2024.01.023

Abstract

Background and aims: Liquid nitrogen spray cryotherapy (SCT) is an alternative to radiofrequency ablation (RFA) for eradication of dysplastic Barrett's esophagus (BE). We aimed to assess the safety, efficacy, and durability of SCT in a multicenter U.S. registry.

Methods: This is a multicenter prospective registry of adults with BE treated with truFreeze Spray Cryotherapy (4 community and 11 academic sites, 2013-2022). Complete eradication of intestinal metaplasia (CEIM) and dysplasia (CED) were assessed in BE with dysplasia or intramucosal adenocarcinoma (IMC). Kaplan-Meier analysis of CEIM and CED was performed. Hazard ratios for CEIM stratified by baseline risk factors were calculated.

Results: Among 138 subjects, with LGD (24%), HGD (49%) and IMC (27%), 34% received prior RFA therapy. Subjects received a median of 2 SCT sessions. Adverse events were uncommon, with 5.5% reporting strictures and 0.7% a perforation. Rates of CEIM and CED, respectively, were 66% and 84% after two years, and 67% and 92% after three years. In RFA-naive patients, CEIM was 77% and CED was 96% at 3 years. Increasing BE length (adjusted hazard ratio [95% CI]:0.90 [0.83-0.96] per cm) and prior treatment with RFA (0.39 [0.22-0.69]) were associated with a lower rate of CEIM. Recurrence occurred in 8.8% (n=6) at a mean follow-up of 2.5 years after CEIM.

Conclusion: In this largest reported prospective cohort, liquid nitrogen SCT was safe and effective for treatment of dysplastic and neoplastic BE. Response was lower in those with prior failed RFA; in that cohort approximately 50% attained CEIM at 3 years.

Keywords: Barrett’s esophagus; cryotherapy; endoscopic eradication; esophageal adenocarcinoma.