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Cryoballoon Ablation Has Similar Efficacy to but Higher Stricture Rates Than Radiofrequency Ablation in Barrett’s Endoscopic Therapy

Prateek Sharma, MD, FASGE, reviewing Agarwal S, et al. Gastrointest Endosc 2021 Oct 5.

Radiofrequency ablation (RFA) is widely utilized in the treatment of neoplastic Barrett’s esophagus (BE) after endoscopic resection of all visible lesions. Cryotherapy is another form of BE endoscopic therapy (BET), which utilizes a spray catheter using either liquid nitrogen or carbon dioxide to freeze tissue, causing both immediate and delayed tissue necrosis. Cryoballoon ablation (CBA) is a newer technology that delivers cryotherapy with a balloon catheter. This study compared outcomes between RFA and CBA.

The retrospective, 2-center study evaluated all patients in their database from 2014 to 2020 who underwent CBA or RFA as their initial ablation treatment type. Of 311 patients included in the study, 226 received RFA (mean age, 65.6; 78% male) and 85 received CBA (mean age, 67.1; 84% male) as their primary ablation therapy. The patient groups were similar in demographics, baseline histology, and the presence of long-segment BE. Most patients who received CBA were initially treated with endoscopic mucosal resection (EMR); however, those who received RFA had nearly similar primary treatment with endoscopic submucosal dissection (ESD) or EMR. 

The median time to follow-up from the initial ablation was 1.5 years (0.8-2.5 years) for the RFA group versus 2.0 years (1.3-2.5 years) for the CBA group. The probability of reaching complete eradication of intestinal metaplasia (CE-IM) was similar between the ablation types (CBA vs RFA hazard ratio [HR], 1.13; 95% confidence interval [CI], 0.80-1.60; P=.5). This did not change when using multivariate analysis for those with BE length ≤6 cm (n=235; HR, 1.25; 95% CI, 1.25 [0.87-1.80]; P=.23). Additionally, with 1:1 propensity-matched analysis, CBA compared similarly to RFA for achieving CE-IM (CBA vs RFA HR, 1.24; 95% CI, 0.79-1.96; P=.35). Longer BE segment length was independently found to influence the efficacy of either modality from achieving complete eradication of dysplasia (CE-D), with an HR of 0.94 per centimeter increase in BE length (P= .01). Strictures requiring dilation occurred significantly higher in the CBA group (10.6%) compared with the RFA group (4.4%; P=.04).

Prateek Sharma, MD, FASGE

COMMENT

This retrospective study shows that BET with CBA was similar to RFA in achieving CE-IM and C-D and that stricture rates were twice as high in the CBA group compared to the RFA group.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Agarwal S, Alshelleh M, Scott J, et al. Comparative outcomes of radiofrequency and cryoballoon ablation in dysplastic Barrett’s esophagus: a propensity score-matched cohort study. Gastrointest Endosc 2021 Oct 5. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2021.09.037)

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