Endoscopic resection combined with the Cryoballoon focal ablation system in the porcine normal esophagus: a preclinical study

Hajime Sunakawa ,Yusuke Yoda,Toshikazu Kadota ,Satoshi Fujii,Takeo Fujita,Kenji Takagi ,Tetsuo Akimoto,Nobuyoshi Takeshita,Hiro Hasegawa,Tomonori Yano

doi:10.1186/s12876-021-01819-0

Hajime Sunakawa , Yusuke Yoda + Show 8 more

Open Access

https://doi.org/10.1186/s12876-021-01819-0

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Abstract

BackgroundThe Cryoballoon focal ablation system (CbFAS) for dysplastic Barrett’s esophagus is simple, time-saving and has high therapeutic efficacy. This study aimed to evaluate the technical feasibility and tissue damage with combination therapy of endoscopic resection (ER) and CbFAS in porcine models.MethodsThree pigs (A, B, and C) were included, and all ER procedures were performed by endoscopic mucosal resection using the Cap method (EMR). Combination therapy for each pig was performed as follows: (a) CbFAS was performed for a post-EMR mucosal defect for Pig A; (b) CbFAS for post-EMR scar for Pig B, and (c) EMR for post-CbFAS scar for Pig C. All pigs were euthanized at 32 days after the initial procedure, and the tissue damage was evaluated.ResultsAll endoscopic procedures were followed as scheduled. None of the subjects experienced anorexia, rapid weight loss, bleeding, and perforation during the observation period. They were euthanized at 32 days after the initial endoscopic procedure. On histological assessment, there was little difference between the tissue that was treated with CbFAS alone and that treated with CbFAS in combination with ER.ConclusionCombination therapy with ER and CbFAS can be technically feasible, and its outcome was not significantly different from CbFAS alone in terms of tissue damage.

Highlights

Endoscopic resection (ER), including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), is widely accepted as a minimally invasive treatment for superficial esophageal squamous cell carcinoma (SESCC) [1]
Cryoablation works by making a cold ablations injury to the cells in the tissue while preserving the collagen matrix architecture
It differs from tissue-heating ablations such as radiofrequency ablation (RFA), which sometimes develop the fibrosis or stricture of esophageal lumen

Summary

Introduction

Endoscopic resection (ER), including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), is widely accepted as a minimally invasive treatment for superficial esophageal squamous cell carcinoma (SESCC) [1]. Cryoablation works by making a cold ablations injury to the cells in the tissue while preserving the collagen matrix architecture. It differs from tissue-heating ablations such as radiofrequency ablation (RFA), which sometimes develop the fibrosis or stricture of esophageal lumen. There is limited data on combination therapy with ER and CbFAS for SESCCs. The Cryoballoon focal ablation system (CbFAS) for dysplastic Barrett’s esophagus is simple, time-saving and has high therapeutic efficacy. This study aimed to evaluate the technical feasibility and tissue damage with combination therapy of endoscopic resection (ER) and CbFAS in porcine models

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