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Cryoballoon, cryospray found equivalent for eradicating Barret’s esophagus
Key clinical point: Cryoballoon and cryospray therapies appear to be equivalent in eradicating dysplastic Barrett’s esophagus.
Major finding: At 18 months, rates of complete eradication of dysplasia were 95.6% in patients who received cryoballoon therapy and 96% in recipients of cryospray. Rates of complete eradication of intestinal metaplasia were 84.75% and 80%, respectively.
Study details: A single-center retrospective study of 71 patients with dysplastic Barrett’s esophagus who had not previously received ablation; 46 patients received cryoballoon and 25 received cryospray.
Disclosures: The investigators reported receiving no grant support. One investigator disclosed ties to Olympus America, Pentax Medical Research, and Ninepoint Medical.
Alshelleh M et al. Tech Innov Gastrointest Endosc. 2020 Jul 26. doi: 10.1016/j.tige.2020.07.004.
The role of cryotherapy in Barrett’s esophagus eradication continues to evolve. Early data on liquid nitrogen (LN) cryospray included patients who failed radiofrequency ablation or had long segment or nodular disease, resulting in eradication rates lower than those for RFA. More recent studies, with cohorts similar to RFA studies, show comparable results with LN cryospray and the newer nitrous oxide cryoballoon. Cryotherapy tends to produce less postprocedure pain compared with RFA, especially when treating longer segments, and this is a common reason for choosing cryotherapy. This study by Alshelleh et al. compared complete eradication rates of dysplasia and intestinal metaplasia between cryospray and cryoballoon in a retrospective single-center study. Complete eradication rate of dysplasia was 95%-96% and that of intestinal metaplasia was 80%-85%, comparable with reported results for RFA.
How do these technologies differ? The cryoballoon catheter is self-contained and relatively inexpensive, while cryospray requires a console with LN tank and a decompression tube venting nitrogen gas during spray. The cryoballoon can treat only a small mucosal area with each freeze (although a hemicircumferential catheter is under study), while cryospray can “paint” a larger area with LN. A new cryospray catheter is under development that delivers circumferential treatment over several centimeters of tissue, like the RFA balloon catheter. The ability of the cryospray device to deliver essentially unlimited cold energy makes it useful in ablation of esophageal cancer, as well as for pulmonary and ENT applications. Expect improvement in both technologies, along with a better understanding of their role in ablation of Barrett’s and other tissues.
Bruce D. Greenwald, MD, is a professor of medicine in the division of gastroenterology and hepatology at the University of Maryland, Baltimore. He receives research funding from and serves as a consultant for Steris.