Liquid Nitrogen Cryotherapy shows good long-term results for treating Barrett’s oesophagus

Liquid nitrogen spray cryotherapy (LNSCT) has been shown to be a safe, well-tolerated, and effective therapy for cellular changes occurring with Barrett’s oesophagus (BE). A new study, “Outcomes after liquid nitrogen spray cryotherapy in Barrett’s oesophagus–associated high-grade dysplasia and intramucosal adenocarcinoma: 5-year follow-up,” provided previously lacking follow-up to determine long-term efficacy of the treatment.
LNSCT uses liquid nitrogen to “freeze” and destroy diseased tissue. The study looked at treatment of BE-associated high-grade dysplasia (BE-HGD) and intramucosal (within the esophageal lining) adenocarcinoma (IMC).
In this single-centre, retrospective study, patients with BE-HGD/IMC of any length treated with LNSCT were followed with surveillance endoscopy with biopsy for three to five years. Patients with IMC completely removed by endoscopic resection were included. Outcome measures included complete eradication of HGD (CE-HGD), dysplasia, and intestinal metaplasia; incidence rates; durability of response; location of recurrent intestinal metaplasia and dysplasia; and rate of disease progression.
There were 50 patients in the three-year analysis, and 40 patients in the five-year analysis. Initial complete eradication of HGD, dysplasia, and intestinal metaplasia was achieved in 98 percent, 90 percent, and 60 percent, respectively. At the three-year follow-up, these measures were 96 percent (48/50), 94 percent (47/50), and 82 percent (41/50). At five years, they were 93 percent (37/40), 88 percent (35/40), and 75 percent (30/40). These results allow for retreatment or interval touch-up with ablation during the follow-up period.
Incidence rates of recurrent intestinal metaplasia, dysplasia, and HGD/oesophageal adenocarcinoma after initial complete eradication of intestinal metaplasia (CE-IM) were 12.2%, 4.0%, and 1.4% per person-year for the 5-year cohort. Two of seven HGD recurrences occurred later than four years after initial eradication, and two patients (4 percent) progressed to adenocarcinoma despite treatment.
The authors concluded that, in patients with BE-HGD/IMC, LNSCT is effective in eliminating dysplasia and intestinal metaplasia. Progression to adenocarcinoma was uncommon, and recurrence of dysplasia was successfully treated in most cases. Long-term surveillance is necessary to detect late recurrence of dysplasia.

American Society for Gastrointestinal Endoscopy