Safety and efficacy of liquid nitrogen spray cryotherapy in Barrett’s neoplasia – a comprehensive review and meta-analysis

Saurabh Chandan; Jay Bapaye; Shahab R. Khan; Smit Deliwala; Babu P. Mohan; Daryl Ramai; Banreet S. Dhindsa; Hemant Goyal; Lena L. Kassab; Muhammad Aziz; Faisal Kamal; Antonio Facciorusso; Douglas G. Adler

doi:10.1055/a-1906-4967

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(11): E1462-E1473
DOI: 10.1055/a-1906-4967

Original article

Safety and efficacy of liquid nitrogen spray cryotherapy in Barrett’s neoplasia – a comprehensive review and meta-analysis

Saurabh Chandan

¹Division of Gastroenterology & Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, United States

,

Jay Bapaye

²Department of Internal Medicine, Rochester General Hospital, Rochester, New York, New York, United States

,

Shahab R. Khan

³Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States

,

Smit Deliwala

⁴Internal Medicine, Hurley Medical Center, Flint, Michigan, United States

,

Babu P. Mohan

⁵Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States

,

Daryl Ramai

⁵Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States

,

Banreet S. Dhindsa

⁶Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States

,

Hemant Goyal

⁷Department of Gastroenterology, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, Unites States

,

Lena L. Kassab

⁸Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States

,

Muhammad Aziz

⁹Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio, United States

,

Faisal Kamal

¹⁰Division of Gastroenterology, University of California-San Francisco, California, United States

,

Antonio Facciorusso

¹¹Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy

,

Douglas G. Adler

¹²Center for Advanced Therapeutic Endoscopy (CATE), Centura Health, Porter Adventist Hospital, Denver, Colorado, United States

› Author Affiliations

Abstract

Background and study aims Barrett’s esophagus (BE) is a precursor condition to esophageal adenocarcinoma (EAC), resulting in transformation of the squamous epithelium of distal esophagus to columnar-lined epithelium with intestinal metaplasia (IM). Liquid nitrogen spray cryotherapy (LNSC) is a non-contact method of BE eradication and has been used both as primary and salvage therapy. We conducted a systematic review and meta-analysis to assess the safety and efficacy of LNSC.

Methods We searched multiple databases from inception through December 2021 to identify studies on use of LNSC for Barrett’s neoplasia. Pooled estimates were calculated using random-effects model and results were expressed in terms of pooled proportions with relevant 95 % confidence intervals (CIs) of complete eradication (CE) of dysplasia(D), high grade dysplasia (HGD) and IM.

Results Fourteen studies with 707 patients were included in our final analysis. Overall pooled rates of CE-D, CE-HGD and CE-IM were 80.8 % (CI 77.4–83.8; I² 62), 90.3 % (CI 85.2–93.7; I² 33) and 55.8 % (CI 51.7–59.8; I² 73) with follow up ranging from 4.25 months to 69.7 months. In patients with follow up beyond 24 months, the rates of CE-D and CE-IM were 83.6 % (CI 77.6–88.2; I² 60) and 54.7 % (CI 47.6–61.6; I² 81). Among LNSC naïve patients with prior history of endoscopic resection, the rates were 79.9 % (CI 73.3–85.2; I² 50) and 67.1 % (CI 59.5–73.8; I² 0). Pooled rate of therapeutic failures, defined as lack of response to LNSC therapy, was 23.6 % (CI 19.4–28.3; I² 73). Post LNSC strictures and perforation pooled rates were 4 % and 0.8 %, respectively, which are similar to those previously reported for RFA.

Conclusions Our analysis suggests that liquid nitrogen spray cryotherapy is an acceptable treatment for BE in both ablation naïve and experienced patients.

Full Text

References

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Supplementary Material

Supplementary material