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Liquid nitrogen cryospray ablation in palliation of Barrett’s esophagus–associated adenocarcinoma

      A 56-year-old woman with multiple comorbidities presented with dysphagia and endoscopic examination revealed an esophageal mass with associated Barrett’s esophagus. The mass was 6 cm long (Fig. 1A), and histologic examination showed adenocarcinoma. Echoendoscopic staging showed a T2 lesion, but staging was incomplete because the radial echoendoscope could not traverse the malignant stricture. The patient was referred for oncology, surgical, and radiation oncology evaluation, but given her comorbidities she was determined not to be a candidate for those therapies. She was referred for endoscopic liquid nitrogen cryospray ablation therapy because she refused an esophageal stent. Cryotherapy was performed by use of a dosimetry of 3 30-second freezes at each area of the mass (Fig. 1B; Video 1, available online at www.giejournal.org). The patient noticed improvement after the first session 4 days after the cryotherapy. She returned for 2 more sessions, 4 weeks apart. Her diet progressed from pureed food to solid food throughout the therapy. By the fourth session, the adult gastroscope passed freely (Fig. 1C, Video 1). There was a marked decrease in tumor mass and increase in lumen patency. Liquid nitrogen cryospray ablation therapy may be an effective means of palliative therapy in esophageal cancer.
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      Figure 1A, Distal segment of the mass causing a stricture in the distal esophagus before treatment. B, Cryotherapy of the distal segment of the mass in the distal esophagus. C, Endoscopic view after 3 sessions of cryotherapy in the portion of the distal mass of the esophagus showing marked decrease in tumor mass and increase in lumen patency.
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