The most recently published articles relate to the CryoBalloon focal ablation system. This device was developed to overcome disadvantages of the spraying technique, which include the need for gas venting, operator dependency and possible unequal distribution. First, a safety and feasibility study with the CryoBalloon was performed in 39 patients who received 62 ablations [22▪]. Ninety percentage of ablations were performed successfully, and squamous regeneration was seen in 100% with ablations of 10 s and a mean procedure time of 7 min. Twenty-seven percentage of patients reported pain, but none required analgesics. However, in each patient only one or two ablations of 2 cm2 each were delivered instead of ablation of the full BE segment. Next, the potential of this device for precise targeting of BE islands was investigated [13▪]. BE islands were adequately targeted (44/47) and CE-IM was observed in 100% of the completely ablated areas. Twenty-seven percentage of patients reported chest discomfort without need for analgesics. Again, only one or two focal ablations of about 2 cm2 were applied in each patient. Currently, the efficacy and safety of multiple side-by-side ablations using the CryoBalloon focal ablation system are being investigated. Preliminary results were presented with a median follow-up of 6 months [23▪]. Overall rates of CE-D and CE-IM were 95 and 71%, respectively.
Papers of particular interest, published within the annual period of review, have been highlighted as:
1. Thrift AP, Whiteman DC. The incidence of esophageal adenocarcinoma continues to rise: analysis of period and birth cohort effects on recent trends. Ann Oncol 2012; 23:3155–3162.
2. Weusten B, Bisschops R, Coron E, et al. Endoscopic management of Barrett's esophagus
: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2017; 49:191–198.
3. May A, Gossner L, Pech O, et al. Local endoscopic therapy for intraepithelial high-grade neoplasia and early adenocarcinoma in Barrett's oesophagus: acute-phase and intermediate results of a new treatment approach. Eur J Gastroenterol Hepatol 2002; 14:1085–1091.
4. Pech O, Behrens A, May A, et al. Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett's oesophagus. Gut 2008; 57:1200–1206.
5. Phoa KN, Pouw RE, Bisschops R, et al. Multimodality endoscopic eradication for neoplastic Barrett oesophagus: results of an European multicentre study (EURO-II). Gut 2016; 65:555–562.
6. Shaheen NJ, Sharma P, Overholt BF, et al. Radiofrequency ablation in Barrett's esophagus
with dysplasia. N Engl J Med 2009; 360:2277–2288.
7. Shaheen NJ, Peery AF, Hawes RH, et al. Quality of life following radiofrequency ablation of dysplastic Barrett's esophagus
. Endoscopy 2010; 42:790–799.
8. Baust JG, Gage AA, Bjerklund Johansen TE, Baust JM. Mechanisms of cryoablation
: clinical consequences on malignant tumors. Cryobiology 2014; 68:1–11.
9. Gage AA, Baust JM, Baust JG. Experimental cryosurgery investigations in vivo. Cryobiology 2009; 59:229–243.
10▪▪. Ghorbani S, Tsai FC, Greenwald BD, et al. Safety and efficacy of endoscopic spray cryotherapy
for Barrett's dysplasia: results of the National Cryospray Registry. Dis Esophagus 2016; 29:241–247.
This is the largest prospective multicenter study reporting cryotherapy with liquid nitrogen to be safe and effective in eradicating Barrett's epithelium, especially in short Barrett segments.
11. Sreenarasimhaiah J. Endoscopic applications of cryospray ablation therapy-from Barrett's esophagus
and beyond. World J Gastrointest Endosc 2016; 8:546.
12▪. Verbeek RE, Vleggaar FP, Ten Kate FJ, et al. Cryospray ablation using pressurized CO2
for ablation of Barrett's esophagus
with early neoplasia: early termination of a prospective series. Endosc Int open 2015; 3:E107–E112.
This study was early terminated because of low efficacy of cryospray therapy with carbon dioxide. These results are in contrast with previously performed studies with the same technique.
13▪. Künzli H, Schölvinck D, Meijer S, et al. Efficacy of the CryoBalloon Focal Ablation System for the eradication of dysplastic Barrett's esophagus
islands. Endoscopy 2016; 49:169–175.
Barrett's esophagus islands were adequately targeted with the CryoBallon Focal Ablation System and adequately targeted islands showed complete eradication of Barrett's epithelium.
14. Erinjeri JP, Clark TWI. Cryoablation
: mechanism of action and devices. J Vasc Interv Radiol 2010; 21:S187–S191.
15. Shaheen NJ, Greenwald BD, Peery AF, et al. Safety and efficacy of endoscopic spray cryotherapy
for Barrett's esophagus
with high-grade dysplasia. Gastrointest Endosc 2010; 71:680–685.
16. Greenwald BD, Dumot JA, Horwhat JD, et al. Safety, tolerability, and efficacy of endoscopic low-pressure liquid nitrogen spray cryotherapy
in the esophagus. Dis Esophagus 2010; 23:13–19.
17. Haidry RJ, Butt MA, Dunn JM, et al. Improvement over time in outcomes for patients undergoing endoscopic therapy for Barrett's oesophagus-related neoplasia: 6-year experience from the first 500 patients treated in the UK patient registry. Gut 2015; 64:1192–1199.
18. Phoa KN, Pouw RE, Bisschops R, et al. Multimodality endoscopic eradication for neoplastic Barrett oesophagus: results of an European multicentre study (EURO-II). Gut 2016; 65:555–562.
19▪. Sengupta N, Ketwaroo GA, Bak DM, et al. Salvage cryotherapy
after failed radiofrequency ablation for Barrett's esophagus
-related dysplasia is safe and effective. Gastrointest Endosc 2015; 82:443–448.
This study reports cryotherapy to be safe as salvage therapy for refractory dysplasia or recurrent dysplasia after RFA. Caution is warranted, since RFA refractoriness should raise suspicion for reflux esophagitis or malignancy.
20. Weusten BLAM, Bergman JJGHM. Cryoablation
for managing Barrett's esophagus
refractory to radiofrequency ablation? Don’t embrace the cold too soon!. Gastrointest Endosc 2015; 82:449–451.
21. Canto M, Shin E, Khashab M, et al. Safety and efficacy of carbon dioxide cryotherapy
for treatment of neoplastic Barrett's esophagus
. Endoscopy 2015; 47:582–591.
22▪. Schölvinck D, Künzli H, Kestens C, et al. Treatment of Barrett's esophagus
with a novel focal cryoablation
device: a safety and feasibility study. Endoscopy 2015; 47:1106–1112.
This is a study on a new technology for cryoablation: the CryoBalloon Focal Ablation device. This device is developed because of possible advantages over the spraying technique with no need for gas venting and possibly a more equal distribution of the cryoablation.
23▪. Canto MI, Shin EJ, Khashab MA, et al. 638 Multifocal nitrous oxide CryoBalloon ablation with or without endoscopic mucosal resection (EMR) for treatment of neoplastic Barrett's esophagus
(Be): preliminary results of a prospective clinical trial in treatment-naive and previously ablated patients. Gastrointest Endosc 2016; 83:AB159.
Preliminary results of this study are the first data on performing multifocal ablations with the CryoBalloon.
24. Gosain S, Mercer K, Twaddell WS, et al. Liquid nitrogen spray cryotherapy
in Barrett's esophagus
with high-grade dysplasia: long-term results. Gastrointest Endosc 2013; 78:260–265.
25. Phoa KN, van Vilsteren FGI, Weusten BLAM, et al. Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia. JAMA 2014; 311:1209.
26. Halsey K, Chang J, Waldt A, Greenwald B. Recurrent disease following endoscopic ablation of Barrett's high-grade dysplasia with spray cryotherapy
. Endoscopy 2011; 43:844–848.
27. Xue H, Tan H, Liu W, et al. A pilot study of endoscopic spray cryotherapy
by pressurized carbon dioxide gas for Barrett's esophagus
. Endoscopy 2011; 43:379–385.
28▪▪. Ramay FH, Cui Q, Greenwald BD. Outcomes after liquid nitrogen spray cryotherapy
in Barrett's esophagus
-associated high-grade dysplasia and intramucosal adenocarcinoma: 5-year follow-up. Gastrointest Endosc 2017; Feb 21. pii: S0016-5107(17)30108-6. doi: 10/1016/j.gie.2017.02.006.
The is the first study reporting long-term outcomes 5 years after cryospray therapy with liquid nitrogen.
29. Orman ES, Kim HP, Bulsiewicz WJ, et al. Intestinal metaplasia recurs infrequently in patients successfully treated for Barrett's esophagus
with radiofrequency ablation. Am J Gastroenterol 2013; 108:187–195.
30. Gupta M, Iyer PG, Lutzke L, et al. Recurrence of esophageal intestinal metaplasia after endoscopic mucosal resection and radiofrequency ablation of Barrett's esophagus
: results from a US multicenter consortium. Gastroenterology 2013; 145:79–86. e1.
31. Vaccaro BJ, Gonzalez S, Poneros JM, et al. Detection of intestinal metaplasia after successful eradication of Barrett's esophagus
with radiofrequency ablation. Dig Dis Sci 2011; 56:1996–2000.
32. Gray NA, Odze RD, Spechler SJ. Buried metaplasia after endoscopic ablation of Barrett's esophagus
: a systematic review. Am J Gastroenterol 2011; 106:1899–1908.
33. Johnston MH, Eastone JA, Horwhat JD, et al. Cryoablation
of Barrett's esophagus
: a pilot study. Gastrointest Endosc 2005; 62:842–848.