Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jan 16, 2022; 14(1): 17-28
Published online Jan 16, 2022. doi: 10.4253/wjge.v14.i1.17
Endoscopic cryotherapy: Indications, techniques, and outcomes involving the gastrointestinal tract
Amaninder Dhaliwal, Syed M Saghir, Harmeet S Mashiana, Annie Braseth, Banreet S Dhindsa, Daryl Ramai, Pushpak Taunk, Rene Gomez-Esquivel, Aamir Dam, Jason Klapman, Douglas G Adler
Amaninder Dhaliwal, Division of Gastroenterology and Advanced Endoscopy, McLeod Regional Medical Center, Florence, SC 29501, United States
Syed M Saghir, Division of Gastroenterology, Creighton University School of Medicine, Omaha, NE 68124, United States
Harmeet S Mashiana, Banreet S Dhindsa, Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE 68198-2000, United States
Annie Braseth, Division of Gastroenterology, University of Iowa, Iowa City, IA 52242-1009, United States
Daryl Ramai, Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT 84132, United States
Pushpak Taunk, Rene Gomez-Esquivel, Division of Gastroenterology, USF Health, Tampa, FL 33612, United States
Aamir Dam, Division of Gastroenterology and Hepatology, Moffitt Cancer Center, Tampa, FL 33612, United States
Jason Klapman, Gastrointestinal Tumor Program, Moffitt Cancer Center, Tampa, FL 33612, United States
Douglas G Adler, Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Center Health, Denver, CO 80210, 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: There is no conflict of interest from any of the authors.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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:
Corresponding author: Douglas G Adler, AGAF, FACG, FASGE, MD, Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Center Health, 2525 S Downing St, Denver, CO 80210, United States.
Received: January 8, 2021
Peer-review started: January 8, 2021
First decision: October 17, 2021
Revised: October 31, 2021
Accepted: December 25, 2021
Article in press: December 25, 2021
Published online: January 16, 2022

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.