Copyright ©The Author(s) 2018.
World J Gastroenterol. Nov 21, 2018; 24(43): 4862-4869
Published online Nov 21, 2018. doi: 10.3748/wjg.v24.i43.4862
Table 1 Cryotherapy in Barrett’s esophagus
Author (yr)No. of patientsCryotherapy system usedResults of the studyAdverse events
Johnston et al[21] (2005)11Liquid nitrogen at -196 °C100% CE-D and CE-IM-
Canto et al[26] (2015)44Modified low-pressure CO2 cryotherapy system (Polar Wand, GI supply)95.6% CE-D in LGD, 91.3% CE-D in HGD4.5% (2) developed transient mild discomfort post-procedure.
Dumot et al[42] (2009)30LNSCT (CSA Medical Inc, Baltimore, Md)68% CE-D in HGD, 80% CE-D in IMC3.3% (1) developed perforation in a patient with known Marfan’s syndrome
Ghorbani et al[24] (2016)96LNSCT (2nd generation, CSA Medical, Baltimore, MD, United States)91% CE-D in LGD, 81% CE-D in HGD, 61% CE-IM in LGD and 65% CE-IM in HGD respectively.1% (1) developed stricture, which did not require dilation. 1% (1) hospitalized for bleeding in the setting of NSAID use
Ramay et al[44] (2017)90 (50 for 3-yr analysis, 40 for 5-yr analysis)LNSCT3-yr analysis: 96% CE-D in HGD, 94% CE-D in LGD, 82% CE-IM; 5-yr analysis: 93% CE-D in HGD, 88% CE-D in LGD, 75% CE-IM-
Table 2 Cryotherapy in esophageal cancer
Author (yr)No. of patientsCryotherapy system usedResultsAdverse events
Cryotherapy in EAC
Greenwald et al[29] (2010)79 (49 completed the treatment)Low-pressure liquid nitrogen (< 5 psi) cryotherapy systemCE-D in 32%.Benign strictures (12.6%), pain post treatment (25.3%)
Tsai et al[30] (2017)88Low-pressure liquid nitrogen (< 5 psi) cryotherapy systemCE of intraluminal disease in 76.3% T1a, 45.8% T1b, 66.2% T1, and 6.7% T2Abdominal pain (19.3%), dysphagia (10.2%), sore throat (9%), and chest pain (8%)
Kachaamy et al[32] (2018)49Low-pressure liquid nitrogen system (CryoSpray Ablation System; CSA Medical, Inc, Lexington, Mass)Improvement in mean dysphagia score2% (1) developed a severe intra-procedural perforation, 2% (1) developed a benign stricture requiring dilation.
Cryotherapy in SCC
Cash et al[33] (2007)1Liquid nitrogen cryospray ablation100% CE-DStricture development
Canto et al[34] (2018)10Nitrous oxide (CbFAS)100% CE-D in LGIN, HGIN, SCCPost-procedure pain (40%), esophageal stricture (20%)
Table 3 Radiofrequency ablation vs cryotherapy
Radiofrequency ablationCryotherapy
Mechanism of actionBipolar electrode delivering radiofrequency energy to mucosa which generates heat and causes a uniform thermal injury on contactRapid freeze and thaw cycles cause immediate effects of slowing cellular metabolism and freezing intracellular water. Subsequently, ice formation results in disruption of cellular membranes and organelle dysfunction and eventually cellular apoptosis.
Maximal depth of injuryMucosa (500-1000 microns)Depends on the dose delivered; upto submucosa
Eradication of metaplasia66.7%-100 %41.3%-60% with cryospray; 84%-100% with cryoballoon
Eradication of dysplasia87.5%-100%78.8%-90% with cryospray; 92%-100% with cryoballoon
Post procedure pain requiring analgesics4 d2 d
Side effectsEsophageal strictures in 10.2%, bleeding 1.1%, perforation 0.2%Esophageal strictures in 0%-12.5%, bleeding in 2 cases, perforation in 3 cases
DurabilityCE-D 98% and CE-IM 91% at 3 yrCE-D 92%, and CE-IM 81% at 5 yr (with cryospray only, cryoballoon data not available)
Recurrent metaplasia16.10%13.30%
Recurrent dysplasia2.60%3.60%
Recurrent high grade dysplasia or cancer1.40%1.30%