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Salvage Cryotherapy for Barrett's Esophagus with High Grade Dysplasia after RFA Failure

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Gross, Seth MD1; Zfass, Alvin MD4; Habr, Fadlallah MD6; Lightdale, Charles MD2; Ribeiro, Afonso MD7; Jayaprakash, Sreenarasimhaiah MD5; McKinley, Matthew MD3

American Journal of Gastroenterology: October 2010 - Volume 105 - Issue - p S23–S24
Abstracts: ESOPHAGUS
Free

1. Gastroenterology, Norwalk Hospital, Norwalk, CT; 2. New York-Presbyterian/Columbia, New York, NY; 3. Syosset Hospital, New York, NY; 4. Virginia Commonwealth University Medical Center, Richmond, VA; 5. UT Southwestern Medical Center, Dallas, TX; 6. Rhode Island Hospital - Brown University, Providence, RI; 7. University of Miami, Miami, FL.

Purpose: Barrett's esophagus (BE) with high grade dysplasia (HGD) has the potential to progress to esophageal cancer if left untreated. Endoscopic ablation is an acceptable form of therapy often done with radiofrequency ablation (RFA). There is a subset of patients who continue to have persistent disease despite therapy and may benefit from low-pressure liquid nitrogen cryotherapy.

Methods: A retrospective cohort of patients initially treated with RFA, but continued to have BE- HGD were analyzed in this study. Variables included patient demographics, initial BE length, total RFA sessions, degree of persistent BE after RFA, and results after cryotherapy.

Results: A total of 12 patients were treated with RFA followed by cryotherapy for BE-HGD. The mean age was 69 years (range 53-84 years) and all were males. The mean BE segment was 5.6 cm (range 1-13 cm). In 25% (n=3) of BE-HGD patients endoscopic mucosal resection was done prior to ablation. The mean number of RFA sessions were 2.1 (range 1-4 treatments). In 11/12 (92%) patients BE-HGD persisted after RFA therapy based on biopsies. One patient was downgraded to BE without dysplasia. Patients were then treated with cryotherapy ablation for a mean of 2.3 treatments (range 1-5 treatments). Dosimetry freeze time had a mean of 19 seconds (range 10-30 seconds) repeated 2.6 cycles (range 2-4 cycles) per treatment session. Post cryotherapy biopsies of previous BE-HGD patients were available in 7/12 patients. Complete eradication of BE-HGD was seen in 4/7 patients and these patients were biopsy negative. Two patients only had BE without dysplasia and one patient was downgraded to low grade dysplasia based on biopsies. The remaining five patients demonstrated endoscopic improvement, but biopsies were still pending at time of analysis.

Conclusion: There appears to be a subset of patients who fail RFA ablation for BE-HGD. Low pressure liquid nitrogen should be considered for refractory BE-HGD patients who fail RFA. Futures studies are needed to better define the role of cryotherapy for the endoscopic treatment of BE with dysplasia.

Disclosure: Dr Gross- Consultant CSA Medical.

© The American College of Gastroenterology 2010. All Rights Reserved.