Is Cryoballoon Ablation Ready for Barrett’s Endoscopic Therapy?

Is Cryoballoon Ablation Ready for Barrett’s Endoscopic Therapy?

Prateek Sharma, MD, FASGE, reviewing van Munster SN, et al. Endoscopy 2020 Mar.

The 90˚-swipe cryoballoon ablation system (CbSAS90) is a new technology incorporating cryotherapy that has been proposed to treat Barrett’s esophagus (BE) segments. This technology is reportedly compatible with therapeutic endoscopes wherein a compliant balloon fills with cryogen and cools the esophageal wall to approximately -80 ˚C. A quarter of the esophageal circumference and 3 cm of length is covered in a single application. This is a multicenter prospective study evaluating the safety and efficacy of CbSAS90 as a modality of Barrett’s eradication therapy (BET). 

A total of 25 patients (median age, 67 years; 76% male) with a flat dysplastic BE segment ≤3 cm were enrolled in the study. Median procedure time was 24 minutes, and median ablation time was 10 minutes. The procedure was technically successful (treatment of all BE as intended) in 23 (92%) patients. Phase 1 involved semicircumferential therapy at 0.8 mm/second and 0.7 mm/second, yielding a BE surface regression of 78% and 85%, respectively. In Phase 2, circumferential treatment (2 semicircumferential treatments, 8 weeks apart) showed a BE surface regression of 93%. Overall, 2 (17%) patients developed stenosis requiring dilation. There were no reports of bleeding, perforation with low and acceptable pain, and dysphagia scores.

Prateek Sharma, MD, FASGE

COMMENT

While this novel technology seems feasible, further studies elucidating the dose, the extent of treatment in a single setting, and a head-to-head comparison with current modalities would be required. Stricture rates appear to be quite high. At this time, cryoballoon ablation for BET needs additional testing before it can be applied in the clinical setting.

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)

van Munster SN, Overwater A, Raicu MGM, et al.  A novel cryoballoon ablation system for eradication of dysplastic Barrett’s esophagus: a first-in-human feasibility study. Endoscopy 2020;52:193-201. (https://doi.org/10.1055/a-1024-3967)

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