Background and Aims
Radiofrequency ablation (RFA) is safe and effective for eradicating Barrett’s esophagus
(BE) but is associated with significant postprocedural pain. Alternatively, balloon-based
focal cryoablation (CRYO) has recently been developed, which preserves the extracellular
matrix and might therefore be less painful. Although data for CRYO are still limited,
uncontrolled studies suggest comparable safety and efficacy to RFA in eradicating
limited BE areas. Therefore, secondary endpoints such as pain might become decisive
for treatment selection. We aimed to compare efficacy and tolerability between focal
CRYO and RFA.
Methods
We identified BE patients undergoing focal ablation (either RFA or CRYO) of all visible
BE from our prospective cohort in 2 Dutch referral centers. After ablation, patients
completed a 14-day digital diary to assess chest pain (0-10), dysphagia (0-4), and
analgesics use. A follow-up endoscopy was scheduled after 3 months to assess the BE
surface regression (blindly scored by 2 independent BE expert endoscopists). Outcomes
were BE surface regression; 14-day cumulative scores (area under the curves [AUCs])
for pain, dysphagia, analgesics, and peak pain.
Results
We identified 46 patients (20 CRYO, 26 RFA) with similar baseline characteristics.
The BE regression was comparable (88% vs 90%, P = .62). AUCs for pain, dysphagia, and analgesics were significantly smaller after CRYO
versus RFA (all P < .01). Peak pain was lower after CRYO (visual analog scale 2 vs 4, P < .01), and the duration of pain was also shorter after CRYO (2 vs 4 days, P < .01). CRYO patients used analgesics for 2 days versus 4 days for RFA (P < .01).
Conclusions
In this multicenter, nonrandomized cohort study, we found no differences in efficacy
after a single treatment with CRYO and RFA for short-segment BE. Patients reported
less pain after CRYO as compared with RFA. Moreover, CRYO patients used fewer analgesics.
Our results suggest a different pain course favoring CRYO over RFA, but a randomized
trial is needed for definitive conclusions. (Clinical trial registration number: NCT02249975.)
Graphical abstract
Graphical Abstract
Abbreviations:
AUC (area under the curve), BE (Barrett’s esophagus), CbFAS (cryoballoon focal ablation system), CRYO (cryoablation using the cryoballoon focal ablation system), EAC (esophageal adenocarcinoma), IQR (interquartile range), LGD (low-grade dysplasia), P-PET (postprocedural pain after endoscopic therapy for Barrett’s esophagus [cohort]), 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: June 18, 2018
Accepted:
June 5,
2018
Received:
December 20,
2017
Footnotes
DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: R. Bisschops: Speaker and consultant for GI Solutions Medtronic. J. J. G. H. M. Bergman: Research support recipient and honorarium, consultant, and speaker for GI Solutions Medtronic. J. J. G. H. M. Bergman, B. L. A. M. Weusten: Research support recipeint from C2 Therapeutics. All other authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr Weusten at [email protected]
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Copyright
© 2018 by the American Society for Gastrointestinal Endoscopy
ScienceDirect
Access this article on ScienceDirectLinked Article
- Barrett’s ablation: blowing hot, blowing coldGastrointestinal EndoscopyVol. 88Issue 5
- PreviewThe cryoballoon focal ablation system (CbFAS) is the most recent tool added to the therapeutic repertoire for early Barrett’s neoplasia. On the basis of current robust evidence, radiofrequency ablation (RFA) is the treatment of choice for ablating Barrett’s epithelium, whereas the role of cryoablation is undetermined. In this issue of Gastrointestinal Endoscopy, van Munster et al1 present the first study comparing the efficacy of the CbFAS device with that of RFA in treating early Barrett’s neoplasia.
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