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
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence.J Natl Cancer Inst. 2005; 97: 142-146
- The incidence of adenocarcinoma in Barrett’s esophagus: a prospective study of 170 patients followed 4.8 years.Am J Gastroenterol. 1997; 92: 212-215
- The incidence of adenocarcinoma and dysplasia in Barrett’s esophagus: report on the Cleveland Clinic Barrett’s Esophagus Registry.Am J Gastroenterol. 1999; 94: 2037-2042
- Incidence of esophageal adenocarcinoma in patients with Barrett’s esophagus and high-grade dysplasia: a meta-analysis.Gastrointest Endosc. 2008; 67: 394-398
- Endoscopic management of Barrett’s esophagus: European Society of Gastrointestinal Endoscopy (ESGE) position statement.Endoscopy. 2017; 49: 191-198
- The role of endoscopy in Barrett’s esophagus and other premalignant conditions of the esophagus.Gastrointest Endosc. 2012; 76: 1087-1094
- Remission of Barrett’s esophagus with early neoplasia 5 years after radiofrequency ablation with endoscopic resection: a Netherlands cohort study.Gastroenterology. 2013; 145: 96-104
- Stepwise radical endoscopic resection versus radiofrequency ablation for Barrett’s oesophagus with high-grade dysplasia or early cancer: a multicentre randomised trial.Gut. 2011; 60: 765-773
- Efficacy of radiofrequency ablation combined with endoscopic resection for Barrett’s esophagus with early neoplasia.Clin Gastroenterol Hepatol. 2010; 8: 23-29
- Radiofrequency ablation in Barrett’s esophagus with dysplasia.N Engl J Med. 2009; 360: 2277-2288
- Endoscopic radiofrequency ablation for Barrett’s esophagus: 5-year outcomes from a prospective multicenter trial.Endoscopy. 2010; 42: 781-789
- Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia: a randomized clinical trial.JAMA. 2014; 311: 1209-1217
- Short term side effects after radiofrequency ablation. Are we ready to ablate non-dysplastic Barrett?.Gut. 2011; 60: A59
- Biophysiologic considerations in cryoablation: a practical mechanistic molecular review.Int Braz J Urol. 2011; 37: 693-696
- Cryoablation: mechanism of action and devices.J Vasc Interv Radiol. 2010; 21: S187-S191
- Treatment of Barrett’s esophagus with a novel focal cryoablation device: a safety and feasibility study.Endoscopy. 2015; 47: 1106-1112
- Efficacy of the cryoballoon focal ablation system for the eradication of dysplastic Barrett’s esophagus islands.Endoscopy. 2017; 49: 169-175
- Use of the cryoballoon focal ablation system for the eradication of esophageal neoplasia: a single-center experience.Gastroenterology. 2016; 150: S266
- Percutaneous computed tomography-guided renal mass radiofrequency ablation versus cryoablation: doses of sedation medication used.J Vasc Interv Radiol. 2013; 24: 347-350
- Cryoablation of Barrett’s esophagus: a pilot study.Gastrointest Endosc. 2005; 62: 842-848
- Cryoablation in the management of Barrett’s esophagus.Curr Opin Gastroenterol. 2017; 33: 261-269
- The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria.Gastroenterology. 2006; 131: 1392-1399
- A novel device for ablation of abnormal esophageal mucosa (with video).Gastrointest Endosc. 2011; 74: 182-188
- A simplified regimen for focal radiofrequency ablation of Barrett’s mucosa: a randomized multicenter trial comparing two ablation regimens.Gastrointest Endosc. 2013; 78: 30-38
- Simplified protocol for focal radiofrequency ablation using the HALO90 device: short-term efficacy and safety in patients with dysplastic Barrett’s esophagus.Endoscopy. 2015; 47: 592-597
- A randomised multicentre trial of CHART versus conventional radiotherapy in head and neck cancer.Radiother Oncol. 1997; 44: 123-136
- Comparison of three rating scales for measuring subjective phenomena in clinical research. I. Use of experimentally controlled auditory stimuli.Arch Med Res. 2004; 35: 43-48
- Properties of the neosquamous epithelium after radiofrequency ablation of Barrett’s esophagus containing neoplasia.Am J Gastroenterol. 2009; 104: 1366-1373
- ACG clinical guideline: diagnosis and management of Barrett’s esophagus.Am J Gastroenterol. 2016; 111 (quiz, 1): 30-50
- Safety and efficacy of circumferential radiofrequency ablation of Barrett’s esophagus using a self-sizing RFA balloon catheter: results of a pilot study.Gastrointest Endosc. 2016; 83 ([abstract]): AB555
- Circumferential balloon-based radiofrequency ablation of Barrett’s esophagus with dysplasia can be simplified, yet efficacy maintained, by omitting the cleaning phase.Clin Gastroenterol Hepatol. 2013; 11: 491-498
- Multimodality endoscopic eradication for neoplastic Barrett oesophagus: results of a European multicentre study (EURO-II).Gut. 2016; 65: 555-562
- Nitrous oxide cryotherapy for treatment of esophageal squamous cell neoplasia: initial multicenter international experience with a novel portable cryoballoon ablation system (with video).Gastrointest Endosc. 2018; 87: 574-581
- Pain control requirements for percutaneous ablation of renal tumors: cryoablation versus radiofrequency ablation—initial observations.Radiology. 2005; 237: 366-370
- Cryothermal vs. radiofrequency ablation as atrial flutter therapy: a randomized comparison.Europace. 2013; 15: 420-428
- Efficacy comparison between cryoablation and radiofrequency ablation for patients with cavotricuspid valve isthmus dependent atrial flutter: a meta-analysis.Sci Rep. 2015; 5: 10910
- Cryoablation versus radiofrequency energy for the ablation of atrioventricular nodal reentrant tachycardia (the CYRANO Study): results from a large multicenter prospective randomized trial.Circulation. 2010; 122: 2239-2245
- Defining the clinically important difference in pain outcome measures.Pain. 2000; 88: 287-294
- Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale.Pain. 2001; 94: 149-158
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] .
Identification
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.
- Full-Text
- Preview
