Endoscopy 2019; 51(04): S108-S109
DOI: 10.1055/s-0039-1681489
ESGE Days 2019 oral presentations
Saturday, April 6, 2019 11:00 – 13:00: Esophagus diagnosis and ablation South Hall 1B
Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC CRYOBALLOON ABLATION IS SAFE, WELL-TOLERATED AND HIGHLY EFFECTIVE IN THE ERADICATION OF ESOPHAGEAL SQUAMOUS CELL NEOPLASIA

S van Munster
1   Gastroenterology and Hepatology, Academic Medical Center Amsterdam, Amsterdam, Netherlands
,
Y Ke
2   Dpt. of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
,
S He
2   Dpt. of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
,
Y Zhang
2   Dpt. of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
,
L Xue
2   Dpt. of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
,
N Lv
2   Dpt. of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
,
S Dawsey
3   Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, United States
,
B Weusten
4   Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, Netherlands
5   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, Netherlands
,
J Bergman
6   Gastroenterology and hepatology, Academic Medical Center Amsterdam, Amsterdam, Netherlands
,
G Wang
2   Dpt. of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

Globally, 80% of all esophageal cancers are squamous cell cancer (ESCC), arising from squamous cell neoplasia (ESCN). Although patients with ESCC have poor prognosis, curative endoscopic treatment can be performed for ESCN. ESCN mainly occurs in developing countries, with limited endoscopic expertise and resources. Hence, an easy-to-use, low-cost treatment would be of great value. The cryoballoon focal ablation system (CbFAS) is a novel endoscopic ablation therapy that comprises a portable handle with a through-the-scope catheter containing a conformable balloon. The balloon is simultaneously inflated and cooled, resulting in ice patches of ± 2 cm2. CbFAS is easy to use and requires no capital equipment. We aimed to assess the safety, tolerability and efficacy of CbFAS for eradicating ESCN.

Methods:

In this prospective trial, patients with one flat-type unstained lesion (USL) on Lugol's chromoscopy, < 6 cm and < 50% of the circumference with moderate/high-grade intraepithelial neoplasia (MGIN/HGIN) were enrolled. At baseline, the lesion was treated with side-by-side ablations of 10 seconds. Safety phone calls were performed at days 2, 7 and 30. Follow-up endoscopies with biopsies and retreatment for persisting lesions were performed at 3 month intervals. All patients underwent a 12-months endoscopy.

Results:

We enrolled 80 patients (59 MGIN, 21 HGIN) with a USL of median 3 (IQR 3 – 4)cm. Median 5 (4 – 7) side-by-side ablations were performed per patient, over a median ablation time of 8 (5 – 10) minutes. After a single treatment, 70/78 patients (90%) exhibited CR and 8/78 (10%) had residual USL and were retreated; all had CR 3 months later. At 12 months, 76/78 patients (97%) exhibited CR whereas 2 patients had a recurrent MGIN. No strictures or serious adverse events occurred. Post-procedure median VAS was 1/0/0 at days2/7/30.

Conclusions:

Results of our prospective cohort study in China suggest that CbFAS of ESCN is safe, well-tolerated, and highly effective in inducing endoscopic and histological remission.