Suchniak-Mussari K, Dye CE, Moyer MT, Mathew A, McGarrity TJ, Gagliardi EM, Maranki JL, Levenick JM. Efficacy and safety of liquid nitrogen cryotherapy for treatment of Barrett’s esophagus. World J Gastrointest Endosc 2017; 9(9): 480-485 [PMID: 28979713 DOI: 10.4253/wjge.v9.i9.480]
Corresponding Author of This Article
John M Levenick, MD, Assistant Professor of Medicine, Section of Gastroenterology and Hepatology, Penn State Hershey Medical Center, 500 University Drive, Hershey, PA 17033, United States. jlevenick@pennstatehealth.psu.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
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: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Sep 16, 2017; 9(9): 480-485 Published online Sep 16, 2017. doi: 10.4253/wjge.v9.i9.480
Efficacy and safety of liquid nitrogen cryotherapy for treatment of Barrett’s esophagus
Kristen Suchniak-Mussari, Charles E Dye, Matthew T Moyer, Abraham Mathew, Thomas J McGarrity, Eileen M Gagliardi, Jennifer L Maranki, John M Levenick
Kristen Suchniak-Mussari, Department of Gastroenterology, Allegheny General Hospital, Pittsburgh, PA 15212, United States
Charles E Dye, Matthew T Moyer, Abraham Mathew, Thomas J McGarrity, Eileen M Gagliardi, Jennifer L Maranki, John M Levenick, Section of Gastroenterology and Hepatology, Penn State Hershey Medical Center, Hershey, PA 17033, United States
Author contributions: Suchniak-Mussari K and Levenick JM designed the research; Suchniak-Mussari K performed the data acquisition, primary analysis, and wrote the paper; Dye CE, Moyer MT, Mathew A, McGarrity TJ, Gagliardi EM and Levenick JM analyzed the data and edited the paper; all the authors contributed to this article.
Institutional review board statement: The study was reviewed and approved by the Penn State Hershey Medical Center Institutional Review Board.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Data sharing statement: No additional data are available.
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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: John M Levenick, MD, Assistant Professor of Medicine, Section of Gastroenterology and Hepatology, Penn State Hershey Medical Center, 500 University Drive, Hershey, PA 17033, United States. jlevenick@pennstatehealth.psu.edu
Telephone: +1-717-5313832 Fax: +1-717-5316770
Received: February 10, 2017 Peer-review started: February 14, 2017 First decision: March 22, 2017 Revised: April 19, 2017 Accepted: May 22, 2017 Article in press: May 24, 2017 Published online: September 16, 2017 Processing time: 212 Days and 0.9 Hours
Abstract
AIM
To evaluate the efficacy and safety of liquid nitrogen cryotherapy as a primary or rescue treatment for BE, with and without dysplasia, or intramucosal adenocarcinoma (IMC).
METHODS
This was a retrospective, single-center study carried out in a tertiary care center including 45 patients with BE who was treatment-naïve or who had persistent intestinal metaplasia (IM), dysplasia, or IMC despite prior therapy. Barrett’s mucosa was resected via EMR when clinically appropriate, then patients underwent cryotherapy until eradication or until deemed to have failed treatment. Surveillance biopsies were taken at standard intervals.
RESULTS
From 2010 through 2014, 33 patients were studied regarding the efficacy of cryotherapy. Overall, 29 patients (88%) responded to cryotherapy, with 84% having complete regression of all dysplasia and cancer. Complete eradication of cancer and dysplasia was seen in 75% of subjects with IMC; the remaining two subjects did not respond to cryotherapy. Following cryotherapy, 15 patients with high-grade dysplasia (HGD) had 30% complete regression, 50% IM, and 7% low-grade dysplasia (LGD); one subject had persistent HGD. Complete eradication of dysplasia occurred in all 5 patients with LGD. In 5 patients with IM, complete regression occurred in 4, and IM persisted in one. In 136 cryotherapy sessions amongst 45 patients, adverse events included chest pain (1%), stricture (4%), and one gastrointestinal bleed in a patient on dual antiplatelet therapy who had previously undergone EMR.
CONCLUSION
Cryotherapy is an efficacious and safe treatment modality for Barrett’s esophagus with and without dysplasia or intramucosal adenocarcinoma.
Core tip: Liquid nitrogen based cryotherapy is efficacious as a treatment modality for Barrett’s esophagus, especially dysplastic Barrett’s esophagus, either as a first or second line therapy.
