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CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(07): E904-E911
DOI: 10.1055/a-0902-4587
Original article
Owner and Copyright © Georg Thieme Verlag KG 2019

Salvage cryotherapy in patients undergoing endoscopic eradication therapy for complicated Barrett’s esophagus

Clayton M. Spiceland
1   Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, United States
,
B. Joseph Elmunzer
1   Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, United States
,
Samuel Paros
2   College of Medicine, Medical University of South Carolina, Charleston, South Carolina
,
Logan Roof
2   College of Medicine, Medical University of South Carolina, Charleston, South Carolina
,
Molly McVey
1   Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, United States
,
Robert Hawes
3   Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, United States
,
Brenda J. Hoffman
1   Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, United States
,
Puja S. Elias
1   Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, United States
› Author Affiliations
Further Information

Publication History

submitted 18 January 2019

accepted after revision 26 March 2019

Publication Date:
03 July 2019 (online)

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Abstract

Background and study aims Some patients with dysplastic Barrett’s esophagus (BE) experience suboptimal response to radiofrequency ablation (RFA), endoscopic mucosal resection (EMR), or the combination. Cryotherapy has been used as salvage therapy in these patients, but outcomes data are limited. We aimed to assess clinical outcomes among a large cohort of patients with dysplastic BE whose condition had failed to respond to RFA and/or EMR.

Patients and methods This was a retrospective cohort study of consecutive cases of dysplastic BE or intramucosal carcinoma (IMC) treated with salvage cryotherapy at a tertiary-care academic medical center. The primary goal of cryotherapy treatment was eradication of all neoplasia. The secondary goal was eradication of all intestinal metaplasia. The proportion of patients undergoing salvage cryotherapy who achieved complete eradication of dysplasia (CE-D) and metaplasia (CE-IM), as well as the time to CE-D and CE-IM were calculated.

Results Over a 12-year period, 46 patients received salvage cryotherapy. All patients underwent RFA prior to cryotherapy, either at our center or prior to referral, and 50 % of patients underwent EMR. A majority of patients (54 %) had high-grade dysplasia (HGD) at referral, while 33 % had low-grade dysplasia (LGD), and 13 % had IMC. Overall, 38 patients (83 %) reached CE-D and 21 (46 %) reached CE-IM. Median time to CE-D was 18 months, median number of total interventions (RFA, cryotherapy, and EMR) was five, and median number of cryotherapy sessions was two.

Conclusion Salvage cryotherapy appears safe and effective for treating BE that is refractory to RFA and/or EMR.

 

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