Endoscopic cryotherapy: Indications, techniques, and outcomes involving the gastrointestinal tract

Abstract

Endoscopic cryotherapy is a technique utilized for the ablation of target tissue within the gastrointestinal tract. A cryotherapy system utilizes the endoscopic application of cryogen such as liquid nitrogen, carbon dioxide or liquid nitrous oxide. This leads to disruption of cell membranes, apoptosis, and thrombosis of local blood vessels within the target tissue. Several trials utilizing cryotherapy for Barrett’s esophagus (BE) with variable dysplasia, gastric antral vascular ectasia (GAVE), esophageal carcinoma, radiation proctitis, and metastatic esophageal carcinomas have shown safety and efficacy. More recently, liquid nitrogen cryotherapy (cryodilation) was shown to be safe and effective for the treatment of a benign esophageal stricture which was refractory to dilations, steroid injections, and stenting. Moreover, liquid nitrogen cryotherapy is associated with less post procedure pain as compared to radiofrequency ablation in BE with comparable ablation rates. In patients with GAVE, cryotherapy was found to be less tedious as compared to argon plasma coagulation. Adverse events from cryotherapy most commonly include chest pain, esophageal strictures, and bleeding. Gastric perforations did occur as well, but less often. In summary, endoscopic cryotherapy is a promising and growing field, which was first demonstrated in BE, but the use now spans for several other disease processes. Larger randomized controlled trials are needed before its role can be established for these different diseases.

Keywords: Cryotherapy, Gastric antral vascular ectasia, Barrett’s esophagus, Esophageal cancer, Palliative therapy

Core Tip: Cryotherapy involves freeze-thaw cycles of tissue to eradicate problematic lesions such as Barrett’s esophagus with variable dysplasia, gastric antral vascular ectasia, radiation proctitis, esophageal carcinomas and metastatic esophageal carcinomas. Two of the most used cryotherapy systems involve liquid nitrogen and carbon dioxide. Cryoballoon focal ablation system is another system, but not widely available. Cryotherapy systems have shown efficacy for these conditions even in patients who were refractory to the current standards of care.