Endoscopic eradication therapy with multifocal cryoballoon ablation for Barrett esophagus-related neoplasia: a prospective European multicenter study

Abstract

Background: Focal cryoballoon ablation (FCBA) is a relatively new modality for treatment of Barrett esophagus (BE)-related neoplasia. This study evaluated the efficacy and safety of FCBA for BE. Methods: Patients with BE segments (Prague classification C≤2M≤5) with dysplasia or early cancer were eligible for inclusion. Following endoscopic resection of visible lesions, FCBA was performed at 3-month intervals until complete eradication of BE (maximum five sessions). After ≥2 FCBA sessions, add-on treatment was allowed. Follow-up endoscopy was scheduled at 6 months and annually thereafter. Outcomes were complete eradication of endoscopically visible BE (CE-BE), intestinal metaplasia (CE-IM), and dysplasia (CE-D), durability of treatment response, and adverse events. Results: 107 patients (mean age 65 years, 91 males, median BE C0M2) were included. Endoscopic resection was performed at entry in 65% (69/107). Patients received a median of 2 FCBA treatments. Add-on treatment was performed in 40% (43/107), mainly APC for small remaining islands (38%; 41/107). CE-BE and CE-D were achieved in 94% (101/107; 95%CI 90%–98%) and CE-IM in 91% (97/107; 95%CI 85%–95%), per intention-to-treat analysis. In per-protocol analysis, CE-BE and CE-D was achieved in 100% (101/101; 95%CI 100%–100%), and CE-IM in 96% (97/101; 95%CI 92%–99%). After a median follow-up of 18 months, 96% (97/101; 95%CI 92%–99%) remained free of endoscopically visible BE. Esophageal stricture was the most common adverse event, in 13% (13/101; 95%CI 6%–20%). Conclusion: FCBA was highly effective in selected patients with BE of limited length, although the potential risk for stricture formation warrants further research.

Topics & Concepts