Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 21, 2018; 24(43): 4862-4869
Published online Nov 21, 2018. doi: 10.3748/wjg.v24.i43.4862
Cryotherapy in the management of premalignant and malignant conditions of the esophagus
Pooja Lal, Prashanthi N Thota
Pooja Lal, Department of Internal Medicine, Cleveland Clinic, Cleveland, OH 44195, United States
Prashanthi N Thota, Department of Gastroenterology, Digestive Disease Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, United States
Author contributions: All authors contributed to the conception and design, acquisition of data and drafting of manuscript; all authors approved the final version of the article, including the authorship list.
Conflict-of-interest statement: Authors deny any conflict-of-interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Prashanthi N Thota, MD, Staff Physician, Department of Gastroenterology, Digestive Disease Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States.
Telephone: +1-216-4440780 Fax: +1-216-4454222
Received: August 6, 2018
Peer-review started: August 6, 2018
First decision: October 11, 2018
Revised: October 13, 2018
Accepted: October 21, 2018
Article in press: October 21, 2018
Published online: November 21, 2018

Endoscopic cryotherapy is a relatively new thermal ablative modality used for the treatment of neoplastic lesions of the esophagus. It relies on cycles of rapid cooling and thawing to induce tissue destruction with a cryogen (liquid nitrogen or carbon dioxide) leading to intra and extra-cellular damage. Surgical treatment was once considered the standard therapeutic intervention for neoplastic diseases of the esophagus and is associated with considerable rates of morbidity and mortality. Several trials that evaluated cryotherapy in Barrett’s esophagus (BE) associated neoplasia showed reasonable efficacy rates and safety profile. Cryotherapy has also found applications in the treatment of esophageal cancer, both for curative and palliative intent. Cryotherapy has also shown promising results as salvage therapy in cases refractory to radiofrequency ablation treatment. Cryoballoon focal ablation using liquid nitrogen is a novel mode of cryogen delivery which has been used for the treatment of BE with dysplasia and squamous cell carcinoma. Most common side effects of cryotherapy reported in the literature include mild chest discomfort, esophageal strictures and bleeding. In conclusion, cryotherapy is an effective and safe method for the treatment of esophageal neoplastic processes, ranging from early stages of low grade dysplasia to esophageal cancer.

Keywords: Esophageal cancer, Barrett’s esophagus, Palliative therapy, Cryotherapy

Core tip: Cryotherapy is freezing of tissue to destroy abnormal lesions and has evolving role in mangement of premalignant and malignant conditions of the esophagus. The currently available cryoablation systems in esophagus are cryospray using liquid nitrogen and cryoballoon focal ablation system using liquid nitrous oxide. The eradication rates of metaplasia and dysplasia in Barrett’s esophagus (BE) with cryotherapy are comparable to those with radiofrequency ablation (RFA). In addition, cryotherapy can be used when RFA is ineffective or not possible in patients with BE and for palliative purposes in advanced esophageal cancer.