Cryotherapy

Another option for ablation of Barrett’s esophagus with dysplasia is cryotherapy. 

Cryotherapy works by spraying freezing liquid or gas onto the lining of the esophagus.  The depth of the freezing effect is 1-2 mm.  Cryotherapy has been used in other parts of the gastrointestinal tract, such as the stomach in patients with gastric antral vascular ectasia (watermelon stomach), or in the rectum to treat radiation proctitis.  

There are currently two different types of cryotherapy available for treatment of Barrett’s esophagus.  Each system uses a regular upper endoscope and has a thin tube that is passed through the endoscope and out the tip.  Then cryospray, either liquid nitrogen or freezing carbon dioxide, is sprayed onto the lining of the esophagus.  When cryotherapy is used, the cells lining the esophagus are frozen, which damages them.  The body then makes an inflammatory reaction, gets rid of the damaged cells, and new (normal) esophageal mucosa covers the area where the Barrett’s used to be. 

There are a few papers describing how cryotherapy works. More recently, several research abstracts were presented at Digestive Disease Week 2008, an international gastroenterology research meeting.  One study used the carbon dioxide cryotherapy system and the other used the liquid nitrogen based system.  Both studies looked at patients with high grade dysplasia or tiny (intramucosal) cancers. 

In the liquid nitrogen cryotherapy study, 32 patients participated. For the 20 patients with HGD, 16 had at least a partial response (improvement) after cryotherapy and 50% had complete resolution of their HGD.  For the patients with intramucosal cancer, 6 of 9 had at least a partial response, and 1/3 had complete resolution of their intramucosal cancer. The average number of cryotherapy sessions in the study was 4. The complications included 3 esophageal strictures, 1 lip ulcer, and 1 stomach perforation. 

In the carbon dioxide cryotherapy study, 33 patients participated. The average number of treatments for each patient was 3. 79% of patients had a reduction in the amount of dysplasia and BE.  21% had a complete response, with complete elimination of dysplasia and BE.  3 patients in the study with intramucosal cancer had complete resolution of their cancer after cryotherapy treatment.  One patient had transient mild heartburn after cryotherapy, but no strictures or perforations occurred.

So what’s the take home message about cryotherapy?  It seems to be effective for treating Barrett’s esophagus with dysplasia, but there aren’t as many papers published about it yet.  The two studies mentioned above are ongoing and the final results haven’t been published, so the final outcome of the studies might be better (or possibly worse).  At this point, there are more studies published about photodynamic therapy and radiofrequency ablation for treating Barrett’s esophagus with dysplasia.  So cryotherapy one of the choices for treatment of Barrett’s with dysplasia and worth discussing with your own gastroenterologist.

If you think you may be interested in cryotherapy treatment, there are several ongoing research studies that can be found on clinicaltrials.gov and by searching the internet. 

Here are the references for the 2 cryotherapy studies mentioned above. 

Dumot JA, et al. Results of Cryospray Ablation for Esophageal High Grade Dysplasia (HGD) and Intramucosal Cancer (Imca) in High Risk Non-Surgical Patients.  Gastrointestinal Endoscopy, Volume 67, Issue 5, April 2008, Page AB176

Canto MI, et al. Low Flow CO2-Cryotherapy for High Risk Barrett’s Esophagus (BE) Patients with High Grade Dysplasia and Early Adenocarcinoma: A Pilot Trial of Feasibility and Safety a Pilot Trial of Feasibility and Safety.  Gastrointestinal Endoscopy, Volume 67, Issue 5, April 2008, Pages AB179-AB180

 -posted by Kerry Dunbar, MD

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