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Focal cryoballoon versus radiofrequency ablation of dysplastic Barrett’s esophagus: impact on treatment response and postprocedural pain

      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

      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)
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      Linked Article

      • Barrett’s ablation: blowing hot, blowing cold
        Gastrointestinal EndoscopyVol. 88Issue 5
        • Preview
          The 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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