Su1474 Safety and Efficacy of Endoscopic Spray Cryotherapy for Barrett's Dysplasia: Results of the National Cryospray Registry

Abstract

Safety and Efficacy of Endoscopic Spray Cryotherapy for Barrett’s Dysplasia: Results of the National Cryospray Registry Shireen Ghorbani*, Franklin Tsai, Bruce D. Greenwald, Sunguk Jang, John A. Dumot, Matthew Mckinley, Nicholas J. Shaheen, Fadlallah Habr, Walter Coyle Division of Gastroenterology and Hepatology, Scripps Green Hospital, La Jolla, CA; Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD; Division of Gastroenterology, Cleveland Clinic, Cleveland, OH; Division of Gastroenterology, University Hospitals Case Medical Center, Cleveland, OH; Division of Gastroenterology, Prohealth Syosset Hospital, Lake Success, NY; Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC; Division of Gastroenterology, University Medicine Foundation, Providence, RI Background: Endoscopic spray cryotherapy has been shown to be efficacious in eradicating high-grade dysplasia (HGD) in Barrett esophagus (BE) in multiple retrospective series. However, large prospective series evaluating the safety and efficacy of cryotherapy for Barrett’s dysplasia, particularly low grade dysplasia (LGD), have been lacking. Methods: A multicenter, prospective open-label registry study including subjects with BE and HGD or LGD. Primary outcomes were complete eradication of dysplasia and complete eradication of all intestinal metaplasia. Results: One hundred thirty-four subjects (mean age 67 years, 86% male) with Barrett’s dysplasia (29% LGD, 71% HGD; 37% SSBE, 63% LSBE; mean length 4.2 cm) underwent 464 treatments (mean 3.5 sessions per subject). There were no esophageal perforations, reports of severe pain, or related deaths. Strictures developed in 3 subjects, 2 of which required dilation. One subject was hospitalized for post cryotherapy bleeding in the setting of NSAID use requiring endoscopic hemostasis clip placement. Thirty-four percent of subjects reported mild to moderate post procedure symptoms. For subjects with LGD (mean length 5 cm), 26 (67%) had completed all planned cryotherapy treatments (mean 2.6 sessions) and were included in the efficacy analysis. Twenty-three subjects (88%) had complete eradication of all dysplasia and 16 (62%) had complete eradication of all intestinal metaplasia. For subjects with HGD (mean length 3.9 cm), 82 (86%) had completed all planned cryotherapy treatments (mean 3.5 sessions) and were included in the efficacy analysis. Seventy-five subjects (91%) had complete eradication of HGD, 69 (84%) had complete eradication of all dysplasia and 56 (68%) had complete eradication of all intestinal metaplasia. Conclusions: In the largest prospective cohort to date, short-term data suggest that endoscopic spray cryotherapy is a safe and highly effective modality for eradication of Barrett’s with LGD or HGD.