C2 Balloon Cryotherapy for Symptom Relief in Esophageal Squamous Cell Carcinoma: A Novel Approach: 2017 Presidential Poster Award

Abstract

Introduction: Focal cryoballoon ablation therapy is a relatively new modality that has been reported in treatment of Barrett's esophagus and esophageal squamous cell neoplasia. It is safe and well-tolerated by patients. Here we report a case that highlights the rare use of C2 cryoballoon cryotherapy for symptoms relief in a patient with malignant dysphagia. Case: A 70 year-old female with medical history of atrial fibrillation and hyperplastic colonic polyps presented with a 5-week history of odynophagia and subsequent dysphagia with solids and liquids associated with increasing lower substernal chest pain and 20-lb of weight loss. Patient was found to have a poorly differentiated squamous cell carcinoma in the distal third of the esophagus from 33 to 38 cm with narrowing of the lumen but not fully obstructed. A CT scan demonstrated extensive mediastinal and gastrohepatic lymph node involvement but no metastases to the lungs or liver. In light of worsening of esophageal symptoms, she was initially referred for possible esophageal stent placement. On EGD, a near circumferential fungating mass was found in the lower third of the esophagus, consistent with established locally advanced squamous cell carcinoma of esophagus. Balloon-based TTS (C2 focal catheter) cryotherapy was applied in 6 sessions to the entire lesion using 12 seconds applications. Patient tolerated the procedures well with no complications and was discharged on a soft diet. Esophageal symptoms were greatly alleviated and she was to continue to follow with Oncology and Radiation Oncology.Figure: Circumferential fungating mass in distal third of esophagusFigure: Balloon-based through-the-scope (C2 focal catheter)Discussion: Cryoballoon Focal Ablation System is a novel through-the-scope, balloon catheter, easy-to-use, obviating the need for sizing, with a handle and a small disposable cryogen cartridge. It has been developed for treatment of Barrett's esophagus, including refractory disease, and potentially of esophageal squamous cell carcinoma. We described a case revealing the rare and unique use of C2 balloon cryotherapy for symptoms relief in a patient with locally advanced squamous cell carcinoma of the esophagus. For palliation of malignant dysphagia, esophageal stents are widely used despite their myriad complications. As highlighted in this case, focal cryoballoon ablation is a novel and promising therapy that is relatively safe and effective in achieving resolution of symptoms.Figure: Ablation of esophageal fungating mass using a Balloon-based TTS (C2 focal catheter)