Safety and efficacy of endoscopic spray cryotherapy for Barrett's esophagus with high-grade dysplasia

Nicholas J. Shaheen, Bruce D. Greenwald, Anne F. Peery, John A. Dumot, Norman S. Nishioka, Herbert C. Wolfsen, J. Steven Burdick, Julian A. Abrams, Kenneth Ke Ning Wang, Damien Mallat, Mark H. Johnston, Alvin M. Zfass, Jenny O. Smith, James S. Barthel, Charles J. Lightdale

Research output: Contribution to journalArticle

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Abstract

Background: Endoscopic ablation to treat Barrett's esophagus (BE) with high-grade dysplasia (HGD) is associated with a decreased incidence of esophageal adenocarcinoma. Endoscopic spray cryotherapy (CRYO) demonstrates promising preliminary data. Objective: To assess the safety and efficacy of CRYO in BE with HGD. Design: Multicenter, retrospective cohort study. Setting: Nine academic and community centers; treatment period, 2007 to 2009. Patients: Subjects with HGD confirmed by 2 pathologists. Previous EMR was allowed if residual HGD remained. Interventions: CRYO with follow-up biopsies. Main Outcome Measurements: Complete eradication of HGD with persistent low-grade dysplasia, complete eradication of all dysplasia with persistent nondysplastic intestinal metaplasia, and complete eradication of all intestinal metaplasia. Results: Ninety-eight subjects (mean age 65.4 years, 83% male) with BE and HGD (mean length 5.3 cm) underwent 333 treatments (mean 3.4 treatments per subject). There were no esophageal perforations. Strictures developed in 3 subjects. Two subjects reported severe chest pain managed with oral narcotics. One subject was hospitalized for bright red blood per rectum. Sixty subjects had completed all planned CRYO treatments and were included in the efficacy analysis. Fifty-eight subjects (97%) had complete eradication of HGD, 52 (87%) had complete eradication of all dysplasia with persistent nondysplastic intestinal metaplasia, and 34 (57%) had complete eradication of all intestinal metaplasia. Subsquamous BE was found in 2 subjects (3%). Limitations: Nonrandomized, retrospective study with no control group, short follow-up (10.5 months), lack of centralized pathology, and use of surrogate outcome for decreased cancer risk. Conclusions: CRYO is a safe and well-tolerated therapy for BE and HGD. Short-term results suggest that CRYO is highly effective in eradicating HGD.

Original languageEnglish (US)
Pages (from-to)680-685
Number of pages6
JournalGastrointestinal Endoscopy
Volume71
Issue number4
DOIs
StatePublished - Apr 2010

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Cryotherapy
Barrett Esophagus
Metaplasia
Safety
Retrospective Studies
Esophageal Perforation
Therapeutics
Narcotics
Chest Pain
Rectum
Pathologic Constriction
Adenocarcinoma
Cohort Studies
Pathology
Biopsy
Control Groups
Incidence
Neoplasms

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

Cite this

Shaheen, N. J., Greenwald, B. D., Peery, A. F., Dumot, J. A., Nishioka, N. S., Wolfsen, H. C., ... Lightdale, C. J. (2010). Safety and efficacy of endoscopic spray cryotherapy for Barrett's esophagus with high-grade dysplasia. Gastrointestinal Endoscopy, 71(4), 680-685. https://doi.org/10.1016/j.gie.2010.01.018

Safety and efficacy of endoscopic spray cryotherapy for Barrett's esophagus with high-grade dysplasia. / Shaheen, Nicholas J.; Greenwald, Bruce D.; Peery, Anne F.; Dumot, John A.; Nishioka, Norman S.; Wolfsen, Herbert C.; Burdick, J. Steven; Abrams, Julian A.; Wang, Kenneth Ke Ning; Mallat, Damien; Johnston, Mark H.; Zfass, Alvin M.; Smith, Jenny O.; Barthel, James S.; Lightdale, Charles J.

In: Gastrointestinal Endoscopy, Vol. 71, No. 4, 04.2010, p. 680-685.

Research output: Contribution to journalArticle

Shaheen, NJ, Greenwald, BD, Peery, AF, Dumot, JA, Nishioka, NS, Wolfsen, HC, Burdick, JS, Abrams, JA, Wang, KKN, Mallat, D, Johnston, MH, Zfass, AM, Smith, JO, Barthel, JS & Lightdale, CJ 2010, 'Safety and efficacy of endoscopic spray cryotherapy for Barrett's esophagus with high-grade dysplasia', Gastrointestinal Endoscopy, vol. 71, no. 4, pp. 680-685. https://doi.org/10.1016/j.gie.2010.01.018
Shaheen, Nicholas J. ; Greenwald, Bruce D. ; Peery, Anne F. ; Dumot, John A. ; Nishioka, Norman S. ; Wolfsen, Herbert C. ; Burdick, J. Steven ; Abrams, Julian A. ; Wang, Kenneth Ke Ning ; Mallat, Damien ; Johnston, Mark H. ; Zfass, Alvin M. ; Smith, Jenny O. ; Barthel, James S. ; Lightdale, Charles J. / Safety and efficacy of endoscopic spray cryotherapy for Barrett's esophagus with high-grade dysplasia. In: Gastrointestinal Endoscopy. 2010 ; Vol. 71, No. 4. pp. 680-685.
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abstract = "Background: Endoscopic ablation to treat Barrett's esophagus (BE) with high-grade dysplasia (HGD) is associated with a decreased incidence of esophageal adenocarcinoma. Endoscopic spray cryotherapy (CRYO) demonstrates promising preliminary data. Objective: To assess the safety and efficacy of CRYO in BE with HGD. Design: Multicenter, retrospective cohort study. Setting: Nine academic and community centers; treatment period, 2007 to 2009. Patients: Subjects with HGD confirmed by 2 pathologists. Previous EMR was allowed if residual HGD remained. Interventions: CRYO with follow-up biopsies. Main Outcome Measurements: Complete eradication of HGD with persistent low-grade dysplasia, complete eradication of all dysplasia with persistent nondysplastic intestinal metaplasia, and complete eradication of all intestinal metaplasia. Results: Ninety-eight subjects (mean age 65.4 years, 83{\%} male) with BE and HGD (mean length 5.3 cm) underwent 333 treatments (mean 3.4 treatments per subject). There were no esophageal perforations. Strictures developed in 3 subjects. Two subjects reported severe chest pain managed with oral narcotics. One subject was hospitalized for bright red blood per rectum. Sixty subjects had completed all planned CRYO treatments and were included in the efficacy analysis. Fifty-eight subjects (97{\%}) had complete eradication of HGD, 52 (87{\%}) had complete eradication of all dysplasia with persistent nondysplastic intestinal metaplasia, and 34 (57{\%}) had complete eradication of all intestinal metaplasia. Subsquamous BE was found in 2 subjects (3{\%}). Limitations: Nonrandomized, retrospective study with no control group, short follow-up (10.5 months), lack of centralized pathology, and use of surrogate outcome for decreased cancer risk. Conclusions: CRYO is a safe and well-tolerated therapy for BE and HGD. Short-term results suggest that CRYO is highly effective in eradicating HGD.",
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AU - Shaheen, Nicholas J.

AU - Greenwald, Bruce D.

AU - Peery, Anne F.

AU - Dumot, John A.

AU - Nishioka, Norman S.

AU - Wolfsen, Herbert C.

AU - Burdick, J. Steven

AU - Abrams, Julian A.

AU - Wang, Kenneth Ke Ning

AU - Mallat, Damien

AU - Johnston, Mark H.

AU - Zfass, Alvin M.

AU - Smith, Jenny O.

AU - Barthel, James S.

AU - Lightdale, Charles J.

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N2 - Background: Endoscopic ablation to treat Barrett's esophagus (BE) with high-grade dysplasia (HGD) is associated with a decreased incidence of esophageal adenocarcinoma. Endoscopic spray cryotherapy (CRYO) demonstrates promising preliminary data. Objective: To assess the safety and efficacy of CRYO in BE with HGD. Design: Multicenter, retrospective cohort study. Setting: Nine academic and community centers; treatment period, 2007 to 2009. Patients: Subjects with HGD confirmed by 2 pathologists. Previous EMR was allowed if residual HGD remained. Interventions: CRYO with follow-up biopsies. Main Outcome Measurements: Complete eradication of HGD with persistent low-grade dysplasia, complete eradication of all dysplasia with persistent nondysplastic intestinal metaplasia, and complete eradication of all intestinal metaplasia. Results: Ninety-eight subjects (mean age 65.4 years, 83% male) with BE and HGD (mean length 5.3 cm) underwent 333 treatments (mean 3.4 treatments per subject). There were no esophageal perforations. Strictures developed in 3 subjects. Two subjects reported severe chest pain managed with oral narcotics. One subject was hospitalized for bright red blood per rectum. Sixty subjects had completed all planned CRYO treatments and were included in the efficacy analysis. Fifty-eight subjects (97%) had complete eradication of HGD, 52 (87%) had complete eradication of all dysplasia with persistent nondysplastic intestinal metaplasia, and 34 (57%) had complete eradication of all intestinal metaplasia. Subsquamous BE was found in 2 subjects (3%). Limitations: Nonrandomized, retrospective study with no control group, short follow-up (10.5 months), lack of centralized pathology, and use of surrogate outcome for decreased cancer risk. Conclusions: CRYO is a safe and well-tolerated therapy for BE and HGD. Short-term results suggest that CRYO is highly effective in eradicating HGD.

AB - Background: Endoscopic ablation to treat Barrett's esophagus (BE) with high-grade dysplasia (HGD) is associated with a decreased incidence of esophageal adenocarcinoma. Endoscopic spray cryotherapy (CRYO) demonstrates promising preliminary data. Objective: To assess the safety and efficacy of CRYO in BE with HGD. Design: Multicenter, retrospective cohort study. Setting: Nine academic and community centers; treatment period, 2007 to 2009. Patients: Subjects with HGD confirmed by 2 pathologists. Previous EMR was allowed if residual HGD remained. Interventions: CRYO with follow-up biopsies. Main Outcome Measurements: Complete eradication of HGD with persistent low-grade dysplasia, complete eradication of all dysplasia with persistent nondysplastic intestinal metaplasia, and complete eradication of all intestinal metaplasia. Results: Ninety-eight subjects (mean age 65.4 years, 83% male) with BE and HGD (mean length 5.3 cm) underwent 333 treatments (mean 3.4 treatments per subject). There were no esophageal perforations. Strictures developed in 3 subjects. Two subjects reported severe chest pain managed with oral narcotics. One subject was hospitalized for bright red blood per rectum. Sixty subjects had completed all planned CRYO treatments and were included in the efficacy analysis. Fifty-eight subjects (97%) had complete eradication of HGD, 52 (87%) had complete eradication of all dysplasia with persistent nondysplastic intestinal metaplasia, and 34 (57%) had complete eradication of all intestinal metaplasia. Subsquamous BE was found in 2 subjects (3%). Limitations: Nonrandomized, retrospective study with no control group, short follow-up (10.5 months), lack of centralized pathology, and use of surrogate outcome for decreased cancer risk. Conclusions: CRYO is a safe and well-tolerated therapy for BE and HGD. Short-term results suggest that CRYO is highly effective in eradicating HGD.

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