Salvage Cryotherapy for Treatment of Persistent Barrett’s Esophagus
Barrett’s esophagus can predispose to esophageal adenocarcinoma
after undergoing a histological transformation from non-dysplastic Barrett’s
esophagus to dysplastic Barrett’s esophagus
and subsequently into esophageal adenocarcinoma.
The annual incidence of esophageal adenocarcinoma arising from
Barrett’s esophagus is 0.12%-0.5%.2
The practice guidelines recommend eradication of the entire Barrett’s
esophagus with intra-mucosal adenocarcinoma, high-grade dysplasia and
certain selective cases of low-grade dysplastic Barrett’s esophagus.
This is to prevent esophageal adenocarcinoma arising from Barrett’s esophagus.
This is accomplished by endoscopic eradication therapy,
which consists of initial endoscopic mucosal resection of all visible
nodules in the Barrett’s esophagus and subsequent eradication
of residual Barrett’s esophagus to achieve complete eradication
of intestinal metaplasia (CE-IM).
A CE-IM is defined as absence of endoscopic and histological evidence of
intestinal metaplasia after treatment with ablation therapy.
The risk of metachronous cancer is high if residual Barrett’s
esophagus is not completely eradicated.
There are no randomized control trials between
cryotherapy and RFA to treat Barrett’s esophagus.
The choice of ablative therapy to treat Barrett’s esophagus depends
on the preference of the endoscopist.
A recent meta-analysis on 3802 patients showed efficacy
of RFA in achieving CE-IM was 78% with a mean follow-up
of 20.5 months and majority of these patients required 2-3 RFA
sessions to achieve CE-IM.
Gastro Open J. 2016; 2(1): 1-3. doi: 10.17140/GOJ-2-123