Cryoablation of Dysplasia in Barrett's Esophagus (BE) and Early Stage Esophageal Cancer

Abstract

Background: To determine the efficacy and safety of endoscopic spray cryoablation in the eradication of BE with dysplasia and early stage esophageal cancer. Methods: Ten patients with low grade dysplasia (LGD), high grade dysplasia (HGD) or esophageal cancer were offered endoscopic cryoablation using low pressure liquid nitrogen spray on their esophageal lesions. All histology was confirmed at the Armed Forces Institute of Pathology (AFIP). Distribution was as follows: LGD: 5, HGD: 3, adenocarcinoma (AC): 1, squamous cell carcinoma (SCCA): 1. LGD was treated with two 20 second cryo applications. HGD and cancer were treated with three 20 second cryo applications. The first 5 patients were treated hemi-circumferentially (H) and the last 5 were treated circumferentially (C). Four quadrant surveillance biopsies were taken every 2 cm in the LGD group and every 1 cm in the HGD and cancer groups. Results: The mean age of the treatment group was 66. The mean length of follow-up for all patients was 16 months. Dysplasia was eliminated in all patients with BE. In the patient with adenocarcinoma in BE (T2N0M0), the adenocarcinoma was downgraded to LGD and the patient is undergoing further treatment. The SCCA patient (T2N0M0) is cancer-free 13 months after treatment. There were no major complications with the exception of an esophageal stricture in the SCCA patient which was successfully dilated. Conclusions: Preliminary results using endoscopic cryoablation with low pressure, liquid nitrogen spray has demonstrated efficacy and safety in the elimination of dysplasia in BE, and in the treatment of early stage adenocarcinoma and SCCA of the esophagus warranting further investigation. Tabled 1Cryoablation Table Pt# Age Pre-BE Length (cm) Post-BE Length (cm) Type of Cryo (H/C) Length of Follow-up (mo) # Rxs Dysplasia pre-cryo Dysplasia post-cryo 1 51 1 0 H 32 6 LGD NEG 2 72 8 2 H 32 8 LGD NEG 3 74 5 0 H 27 5 LGD NEG 4 57 4 0 H 21 6 LGD NEG 5 64 6 0 C 16 1 HGD NEG 6 60 3 2 C 10 4 HGD NEG 7 73 6 0 C 6 3 HGD NEG 8 63 4 p C 2 1 AC LGD 9 74 11 p C 3 1 LGD NEG 10 74 na na H 14 2 SCCA NEG Mean 66 5.3 0.6 16.3 3.7 p: pending; na: non-applicable; H: hemi-circumferential; C: circumferential. Open table in a new tab p: pending; na: non-applicable; H: hemi-circumferential; C: circumferential.