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Initial multicenter experience with nitrous oxide cryoballoon for treatment of flat duodenal adenomas (with video)

      Background and Aims

      EMR is the preferred endoscopic therapy for duodenal adenomas (DAs) but is associated with an overall adverse event rate of 26%. Cryotherapy using a Cryoballoon Focal Ablation System (CbFAS) can safely and effectively eradicate esophageal intestinal metaplasia. We report our first experience with cryoballoon ablation for treatment of flat DAs.

      Methods

      This was an American, multicenter, retrospective study involving 5 centers. DAs (Paris 0-IIa and 0-IIb) were treated with nitrous oxide for 5 to 12 seconds using CbFAS. Follow-up EGD was performed at 3 to 12 months.

      Results

      Seventeen DAs (mean size, 22.7 ± 14.3 mm; 12 tubular, 5 tubulovillous) from 13 patients (mean age, 66.5 ± 9.99 years; 61.5% males) were included in the study. Thirteen of 17 DAs (76.5%) had failed previous treatment, and 4 of 17 (23.5%) were treatment naÏve. All procedures were technically successful and achieved a >50% decrease in size after cryoballoon ablation There was no increase in size or progression of disease for any lesions. Overall, treatment was completed in 15 of 17 patients, and recurrence-free survival was achieved in 12 of 17 (71%) after a median follow-up of 15.5 months (interquartile range [IQR], 6.8-19.4). The median cryoablation time per polyp was 4 minutes (IQR, 1-7.5 minutes), and the median total procedure time was 25 minutes (IQR, 22-30.5 minutes). There were no intra- or postprocedural adverse events.

      Conclusions

      Nitrous oxide cryoballoon ablation of nonpolypoid DAs is feasible, with promising safety and efficacy.

      Abbreviations:

      AE (adverse event), APC (argon plasma coagulation), BE (Barrett’s esophagus), CBA (cryoballoon ablation), CbFAS (C2 Cryoballoon Focal Ablation System), DA (duodenal adenoma), ESD (endoscopic submucosal dissection), FAP (familial adenomatous polyposis), HGD (high-grade dysplasia), IQR (interquartile range), SDA (sporadic duodenal adenoma)
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      Linked Article

      • Cryoballoon ablation for duodenal adenomas: Time to warm up to a cool new approach?
        Gastrointestinal EndoscopyVol. 93Issue 1
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          The toolkit available to endoscopists to treat premalignant lesions in the GI tract is formidable and includes a variety of resection and ablation techniques. Their use is based on the morphology and location of the target lesion. These technical advances have led to our current situation, where few benign luminal lesions (ie, adenomas) undergo surgical resection without at least an attempt at endoscopic therapy, which in most cases is safe and highly effective. However, despite the overall effectiveness of endoscopic resection, the adverse events associated with the resection of one lesion in particular can instill angst in even the most seasoned endoscopist: the duodenal adenoma.
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