Système gastro-intestinal et digestif

Abstrait

Efficacy and Durability of Cryospray Ablation for Dysplastic Barrett’s Esophagus

Jayaprakash Sreenarasimhaiah

Background: Dysplastic Barrett's esophagus is the precursor to esophageal adenocarcinoma. While traditional therapy has included surgical resection, several endoscopic ablation techniques have become well-established. The newest of these modalities is cryospray ablation using liquid nitrogen.

Objective: To determine efficacy of cryospray ablation therapy in eradication of Barrett's mucosa and dysplastic tissue as well as the durability of these outcomes.

Methods: A retrospective analysis of 33 consecutive patients who underwent endoscopic cryoablation therapy was performed. Patients were followed at 8 weeks, 6 months, and annually following completion of ablation. Biopsies were taken.

Results: A mean of 2.4 sessions (range 1-4) was performed with a mean follow-up of 12.5 months (range 6-36). 100% of patients with low-grade dysplasia achieved complete eradication of dysplasia at a minimum follow-up of 6 months. 95% of highgrade dysplasia was eradicated at 6 months with 5% having persistent focal low-grade dysplasia. In 9% of cases, intramucosal carcinoma was also treated successfully with cryospray ablation therapy. Overall stricture rate was 3% following ablation therapy. No perforations or other serious complications occurred

Conclusions: Cryoablation therapy offers an effective minimimally-invasive method to treat dysplastic Barrett's esophagus as well as some early intramucosal adenocarcinoma. There is minimal morbidity from this procedure and has potentially durable results at follow-up endoscopic surveillance.