Successful Cryoablation Eradication of an Esophageal Gastrointestinal Stromal Tumor

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Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. They are most commonly found in the stomach but have also been described in other segments of the gastrointestinal tract, including the small intestine and more rarely, the esophagus. For gastric and intestinal GISTs, the current standard of care involves surgery and tyrosine kinase inhibitors. However, the appropriate treatment strategy for the management of esophageal GISTs are less well-established. In this case report, we present a case of an esophageal GIST successfully treated by cryoablation therapy. A 69-year-old male with a prior history of Barrett's esophagus and esophageal adenocarcinoma (T1a disease), previously successfully treated with resection, was found to have a ulcerated 13x5 mm mid esophageal GIST on surveillance esophagogastroduodenoscopy (EGD) and endoscopic ultrasound (EUS). The patient was deemed a poor surgical candidate due to his multiple medical comorbidities and a prior history of a complicated post-operative course following his prior esophageal resection, and so cryoablation therapy was offered. The TruFreeze spray cryotherapy system (CSA Medical Inc, Lexington, MA, USA) was used for this procedure. The tumor was treated for 3 freeze-thaw cycles lasting 30 seconds each. On first followup EUS, the GIST was noted to have decreased in size to 10x2 mm on EUS. At 3-month follow up EGD, the GIST had shrunken considerably, with only a slight bump and subtle vessel dilation noted at the site. Cryotherapy was again performed over this area with three 30-second cycles. The patient did report some post-procedure discomfort this time, which self-resolved over a period of 2 weeks. On subsequent EGD/EUS, the previous site of the GIST was replaced by a small scar. No residual lesion was identified on EUS. Biopsy from the scar had no evidence of GIST, dysplasia or malignancy. Case Highlights: Our case demonstrates the potential for cryoablation therapy to resolve esophageal GISTs without invasive surgical intervention. Cryoablation therapy was successful and well-tolerated by the patient, and no significant adverse events were noted during the procedure or on follow up aside from mild discomfort that self-resolved. Cryotherapy is generally a safe procedure and is associated with low rates of serious adverse events and has the advantage of allowing for repeat sessions or other treatments if necessary.1824_A Figure 1. Endoscopic view of esophageal gastrointestinal stromal tumor1824_B Figure 2. Cryotherapy being applied to GIST1824_C Figure 3. Appearance of GIST at 3-month EGD follow up. Mild bump with dilated vessels noted at site of esophageal GIST