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Medline ® Abstract for Reference 110

of 'Barrett's esophagus: Surveillance and management'

Liquid nitrogen spray cryotherapy in Barrett's esophagus with high-grade dysplasia: long-term results.
Gosain S, Mercer K, Twaddell WS, Uradomo L, Greenwald BD
Gastrointest Endosc. 2013;78(2):260.
BACKGROUND: Liquid nitrogen endoscopic spray cryotherapy can safely and effectively eradicate high-grade dysplasia in Barrett's esophagus (BE-HGD). Long-term data on treatment success and safety are lacking.
OBJECTIVE: To assess the long-term safety and efficacy of spray cryotherapy in patients with BE-HGD.
DESIGN: Single-center, retrospective study.
SETTING: Tertiary-care referral center.
PATIENTS: A total of 32 patients with BE-HGD of any length.
INTERVENTION: Patients were treated with liquid nitrogen spray cryotherapy every 8 weeks until complete eradication of HGD (CE-HGD) and intestinal metaplasia (CE-IM) was found by endoscopic biopsy. Surveillance endoscopy with biopsies wasperformed for at least 2 years.
MAIN OUTCOME MEASUREMENTS: CE-HGD, CE-IM, durability of response, disease progression, and adverse events.
RESULTS: CE-HGD was 100% (32/32), and CE-IM was 84% (27/32) at 2-year follow-up. At last follow-up (range 24-57 months), CE-HGD was 31/32 (97%), and CE-IM was 26/32 (81%). Recurrent HGD was found in 6 (18%), with CE-HGD in 5 after repeat treatment. One patient progressed to adenocarcinoma, downgraded to HGD after repeat cryotherapy. BE segment length ≥3 cm was associated with a higher recurrence of IM (P = .004; odds ratio 22.6) but not HGD. No serious adverse events occurred. Stricture was seen in 3 patients (9%), all successfully dilated.
LIMITATIONS: Retrospective study design, small sample size.
CONCLUSION: In patients with BE-HGD, liquid nitrogen spray cryotherapy has an acceptable safety profile and success rate for eliminating HGD and IM and is associated with a low rate of recurrence or progression to cancer with long-term follow-up.
Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland, USA.