Alex Morrisson - DocGuide
In a study of patients with Barrett’s oesophagus, most were able to achieve complete response to treatment of dysplasia with the use of cyroballoon ablation, researchers reported here at Digestive Disease Week (DDW) 2016.
Of 21 evaluable patients, 20 patients achieved complete response, reported Marcia Canto, MD, Johns Hopkins University, Baltimore, Maryland, and colleagues.
The single-centre, prospective, single-arm clinical trial examined cryoballon ablation in 35 patients with Barrett’s oesophagus. Dr. Canto reported on the 21 patients in the study who were evaluable.
Cryoballoon ablation consists of a portable battery-powered system with a small, hand-held device that converts liquid nitrous oxide to gas resulting in an ice patch of approximately 2 cm2. The gas is contained within a low pressure compliant through-the-scope balloon making contact with the mucosa, obviating the need for intraluminal suction.
At an average of 6.7 months of follow-up, the overall complete response for all dysplasia and cancer was 95% in those evaluable patients. Ten of those patients were naïve to treatment; 11 had undergone previous therapies. The overall complete response for intestinal metaplasia was 15 of the 21 patients.
Of the entire group of patients in the study, 12 were diagnosed with persistent/recurrent disease despite prior therapy. Fourteen patients were diagnosed with low-grade dysplasia, 20 of the patients were diagnosed with high-grade dysplasia, and 1 had intramucosal adenocarcinoma.
Prior to cryoballoon ablation, 37% of patients underwent electronic mucosal resection of the oesophagus. The cryoballon treatments were repeated every 10 to 12 weeks until eradication of intestinal metaplasia.
All procedures were successful except for 2 cases in which there were balloon migrations across strictures leading to incomplete ablation. Median ablation time was 18.3 minutes; median procedure time was 30.5 minutes.
No serious adverse events were noted, said Dr. Canto. There were no perforations or bleeding and no patient had a persistent symptomatic stricture. Three patients developed mild inflammatory stenosis, all of which resolved.
She noted that radiofrequency ablation is an effective method of eradicating Barrett’s oesophagus-related lesions, but it comes with a price -- post-ablation pain, strictures, and bleeding.
“Multifocal nitrous oxide cryoballoon ablation is a promising, safe, and potentially effective endoscopic treatment for primary or rescue therapy of Barrett’s Oesophagus-associated neoplasia,” said Dr. Canto. “Device improvements are ongoing and larger multicentre comparative clinical trials are planned to assess long-term safety and efficacy.”
Digestive Disease Week 2016 is cosponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA), the American Society for Gastrointestinal Endoscopy (ASGE), and the Society for Surgery of the Alimentary Tract (SSAT).
