Background and Aims
Liquid nitrogen spray cryotherapy (LNSCT) has been shown to be a safe, well-tolerated,
and effective therapy for Barrett’s esophagus (BE)–associated high-grade dysplasia
(BE-HGD) and intramucosal adenocarcinoma (IMC). Long-term follow-up is lacking.
Aims
The aim of this study was to assess the efficacy, durability, and rate of neoplastic
progression after LNSCT in BE-HGD/IMC at 3 and 5 years.
Methods
In this single-center, retrospective study drawn from a prospective database, patients
with BE-HGD/IMC of any length treated with LNSCT were followed with surveillance endoscopy
with biopsy for 3 to 5 years. Patients with IMC completely removed by endoscopic resection
were included. Outcome measures included complete eradication of HGD (CE-HGD), dysplasia,
and intestinal metaplasia; incidence rates; durability of response; location of recurrent
intestinal metaplasia and dysplasia; and rate of disease progression.
Results
A total of 50 and 40 patients were included in 3-year and 5-year analyses. Initial
CE-HGD, dysplasia, and intestinal metaplasia achieved in 98%, 90%, and 60%, respectively.
Overall CE-HGD, dysplasia, and intestinal metaplasia at 3 years were 96% (48/50),
94% (47/50), and 82% (41/50), and at 5 years were 93% (37/40), 88% (35/40), and 75%
(30/40). Incidence rates of recurrent intestinal metaplasia, dysplasia, and HGD/esophageal
adenocarcinoma per person-year of follow-up after initial complete eradication of
intestinal metaplasia (CE-IM) were 12.2%, 4.0%, and 1.4% per person-year for the 5-year
cohort. Most recurrences were found immediately below the neosquamocolumnar junction.
Two of 7 HGD recurrences occurred later than 4 years after initial eradication, and
2 patients (4%) progressed to adenocarcinoma despite treatment.
Conclusions
In patients with BE-HGD/IMC, LNSCT is effective in eliminating dysplasia and intestinal
metaplasia. Progression to adenocarcinoma was uncommon, and recurrence of dysplasia
was successfully treated in most cases. Long-term surveillance is necessary to detect
late recurrence of dysplasia.
Abbreviations:
APC (argon plasma coagulation), BE (Barrett’s esophagus), BE-HGD (BE–associated high-grade dysplasia), CE-D (complete eradication of dysplasia), CE-HGD (complete eradication of HGD), CE-IM (complete eradication of intestinal metaplasia), HGD (high-grade dysplasia), IMC (intramucosal adenocarcinoma), LGD (low-grade dysplasia), LNSCT (liquid nitrogen spray cryotherapy), RFA (radiofrequency ablation)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 21, 2017
Accepted:
February 10,
2017
Received:
October 24,
2016
Footnotes
DISCLOSURE: Research support was provided to F. Ramay by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Award T32DK067872. The content is solely the responsibility of the authors and does not necessarily reflect views of the National Institutes of Health. Support was provided to B. Greenwald and Q. Cui by the Frenkil Family Foundation. B. Greenwald is a consultant and advisory board member for, and receives research funding from, CSA Medical, Inc. All other authors disclosed no financial relationships relevant to this publication.
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© 2017 by the American Society for Gastrointestinal Endoscopy
