Both cryoballoon and cryospray ablation therapies are effective in eradicating dysplastic Barrett esophagus, according to the results of a retrospective study published in Techniques and Innovations in Gastrointestinal Endoscopy.

Data from patients (N=71) treated at a tertiary care center between 2015 and 2019 via cryotherapy for eradication of dysplastic Barrett esophagus were analyzed. Patients underwent cryotherapy every 3 months for at least 2 sessions, had no prior cryotherapy, had at least a 12-month follow-up, and had a post-treatment endoscopic biopsy.

Patients underwent either cryoballoon (n=46) or cryospray (n=25) procedures. Patients were majority men (83%), had a mean age of 65.4 years, and a mean Barrett maximum length of 3.4 cm. Overall, 95.77% achieved complete remission of dysplasia and 83.1% achieved complete remission of intestinal metaplasia. Patients in the 2 treatment groups did not differ significantly for baseline characteristics. To avoid cofounders from disease severity, patients were stratified by the grade of their dysplasia.


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The patients treated with cryoballoon or cryospray for their low-grade dysplasia did not differ significantly for gender (men: 88% vs 66.66%; P =.16), age (mean 65.8 vs 65.2 years; P =.85), Barrett maximal length (3.64 cm vs 3.61 cm; P =.98), endoscopic mucosal resection prior to treatment (28% vs 22.22%; P =.55), complete remission of dysplasia (96% vs 100%; P =.67), or complete remission of intestinal metaplasia (84% vs 77.77%; P =.39), respectively.

Similarly, the patients treated with cryoballoon or cryospray for their intramucosal high-grade dysplasia did not differ significantly for gender (men: 76.19% vs 93.75%; P =.16), age (mean 64.8 vs 65.5 years; P =.84), Barrett maximal length (2.8 cm vs 3.5 cm; P =.30), endoscopic mucosal resection prior to treatment (66.66% vs 81.25%; P =.29), complete remission of dysplasia (95.23% vs 93.75%; P =.84), or complete remission of intestinal metaplasia (85.71% vs 81.25%; P =.72), respectively.

Strictures were developed by 9.9% of patients, and endoscopic dilation was required. The rate of strictures did not differ between cryotherapy treatments (P =.65) or between dysplasia severity (low-grade: P =.39 vs high-grade: P =.42).

This study was limited by the fact that patients were not randomly selected for therapy, thereby introducing the possibility for selection bias.

“Our study showed that both cryotherapy modalities are equally effective in eradication of dysplastic Barrett’s,” the researchers concluded. “Prospective studies are needed to confirm this data.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Reference

Alshelleh M, Raphael KL, Inamdar S, et al. Cryoballoon and cryospray ablation therapies are equivalent for eradication of Barrett’s esophagus. Published online July 26, 2020. TIGE. doi: 10.1016/j.tige.2020.07.004