Efficacy of Cryotherapy as a Primary Endoscopic Ablation Modality for Dysplastic Barrett’s Esophagus and Early Esophageal Neoplasia: A Systematic Review and Meta-Analysis

Introduction: Cryotherapy is a cold-based ablative therapy used primarily as second line therapy in patients with Barrett’s esophagus (BE) who have persistent dysplasia after undergoing endoscopic treatment with radiofrequency ablation (RFA). Few studies have described the use of cryotherapy as a primary treatment modality for dysplastic or neoplastic BE. Aim: To evaluate the efficacy of cryotherapy as primary treatment of dysplastic and/or neoplastic BE by conducting a systemic review and meta-analysis. Methods: A systematic search of Medline, Embase, and Web of Science was performed from January 2000 through March 2020. Articles included were observational studies and clinical trials which included patients who had biopsy confirmed dysplastic or neoplastic BE (i.e., high grade dysplasia (HGD), low grade dysplasia (LGD) or intramucosal adenocarcinoma (ImCA)), underwent ≥1 session of cryotherapy, and had a follow-up endoscopy. Primary outcomes were pooled proportions of patients achieving complete eradication of dysplasia (CE-D) and/or intestinal metaplasia (CE-IM) by using a random effects model. Results: Fourteen studies making up 405 patients with follow-up ranging from 3-54 months were included. In 13 studies, a total of 321/405 patients achieved CE-D with a pooled proportion of 84.8% (95% confidence interval [CI] 72.2-94.4), with substantial heterogeneity (I2 = 88.3%). In 13 studies, a total of 321/405 patients achieved CE-D with a pooled proportion of 84.8% (95% confidence interval [CI] 72.2-94.4), with substantial heterogeneity (I2 = 88.3%). Subgroup analysis of only high-quality studies revealed a pooled proportion of CE-D 91.3% (95% CI, 83.0-97.4, I2 = 69.5%) and pooled proportion of CE-IM of 71.6% (95% CI, 59.0-82.9, I2 = 80.9%). Adverse events were reported in 12.2% patients. Conclusion: Cryotherapy is a safe and effective primary therapy for dysplastic/early neoplastic BE. CE-D and CE-IM rates are comparable to those for other ablation modalities, including RFA. Cryotherapy should be considered for primary therapy of dysplastic BE and early esophageal neoplasia.

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Mo1172 EFFICACY OF CRYOTHERAPY AS A PRIMARY TREATMENT FOR DYSPLASTIC BARRETT'S ESOPHAGUS AND EARLY ESOPHAGEAL NEOPLASIA: A SYSTEMATIC REVIEW AND META-ANALYSIS

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2019.03.1259 ◽

2019 ◽

Vol 89 (6) ◽

pp. AB449

Author(s):

Raseen Tariq ◽

Vivek Kaul

Keyword(s):

Systematic Review ◽

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Meta Analysis ◽

Primary Treatment ◽

Esophageal Neoplasia

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Significantly lower annual rates of neoplastic progression in short- compared to long-segment non-dysplastic Barrett’s esophagus: a systematic review and meta-analysis

Endoscopy ◽

10.1055/a-0869-7960 ◽

2019 ◽

Vol 51 (07) ◽

pp. 665-672 ◽

Cited By ~ 8

Author(s):

Viveksandeep Thoguluva Chandrasekar ◽

Nour Hamade ◽

Madhav Desai ◽

Tarun Rai ◽

Venkata Subhash Gorrepati ◽

...

Keyword(s):

Systematic Review ◽

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Meta Analysis ◽

Significant Heterogeneity ◽

Neoplastic Progression ◽

Number Of Patients ◽

The Mean ◽

Surveillance Endoscopy

Abstract Background Although shorter lengths of Barrett’s esophagus (BE) have been associated with a lower risk of neoplastic progression, precise estimates have varied, especially for non-dysplastic BE (NDBE) only. Therefore, current US guidelines do not provide specific recommendations on surveillance intervals based on BE length. We performed a systematic review and meta-analysis of the published literature to examine neoplastic progression rates of NDBE based on BE length. Methods PubMed, Cochrane, Google Scholar, and Embase were comprehensively searched. Studies reporting progression rates in patients with NDBE and > 1 year of follow-up were included. The number of patients progressing to esophageal adenocarcinoma (EAC) and high grade dysplasia (HGD)/EAC in individual studies and the mean follow-up were recorded to derive person-years of follow-up. Pooled rates of progression to EAC and HGD/EAC based on BE length (< 3 cm vs. ≥ 3 cm) were calculated. Results Of the 486 initial studies identified, 10 met the inclusion/exclusion criteria. These included a total of 4097 NDBE patients; 1979 with short-segment BE (SSBE; 10 773 person-years of follow-up) and 2118 with long-segment BE (LSBE; 12 868 person-years). The annual rates of progression to EAC were significantly lower for SSBE compared with LSBE: 0.06 % (95 % confidence interval 0.01 % – 0.10 %) vs. 0.31 % (0.21 % – 0.40 %), respectively; odds ratio (OR) 0.25 (0.11 – 0.56); P < 0.001, as were the rates for the combined endpoint (HGD/EAC): 0.24 % (0.09 % – 0.32 %) vs. 0.76 % (0.43 % – 0.89 %), respectively; OR 0.35 (0.21 – 0.58); P < 0.001. There was no significant heterogeneity among studies. Conclusion The results demonstrate significantly lower rates of neoplastic progression in NDBE patients with SSBE compared with LSBE. BE length can easily be used for risk stratification purposes for NDBE patients undergoing surveillance endoscopy and consideration should be given to tailoring surveillance intervals based on BE length in future US guidelines.

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Systematic review and meta-analysis of the effectiveness of radiofrequency ablation in low grade dysplastic Barrett’s esophagus

Endoscopy ◽

10.1055/a-0588-5151 ◽

2018 ◽

Vol 50 (10) ◽

pp. 953-960 ◽

Cited By ~ 9

Author(s):

Gargi Pandey ◽

Mubashir Mulla ◽

Wyn Lewis ◽

Antonio Foliaki ◽

David Chan

Keyword(s):

Systematic Review ◽

Radiofrequency Ablation ◽

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Meta Analysis ◽

Low Grade ◽

Short Term ◽

Recurrence Rates ◽

Premalignant Condition

Abstract Background Barrett’s esophagus (BE) is a premalignant condition characterized by replacement of the esophageal lining with metastatic columnar epithelium, and its management when complicated by low grade dysplasia (LGD) is controversial. This systematic review and meta-analysis aimed to determine the efficacy of radiofrequency ablation (RFA) in patients with LGD. Methods MEDLINE, EMBASE, and Web of Science were searched for studies including patients with BE-associated LGD receiving RFA (January 1990 to May 2017). The outcome measures were complete eradication of intestinal metaplasia (CE-IM) and dysplasia (CE-D), rates of progression to high grade dysplasia (HGD) or cancer, and recurrence. Results Eight studies including 619 patients with LGD (RFA = 404, surveillance = 215) were analyzed. After a median follow-up of 26 months (range 12 – 44 months), the overall pooled rates of CE-IM and CE-D after RFA were 88.17 % (95 % confidence interval [CI] 88.13 % – 88.20 %; P < 0.001) and 96.69 % (95 %CI 96.67 % – 96.71 %; P < 0.001), respectively. When compared with surveillance, RFA resulted in significantly lower rates of progression to HGD or cancer (odds ratio [OR] 0.07, 95 %CI 0.02 – 0.22). The pooled recurrence rates of IM and dysplasia were 5.6 % (95 %CI 5.57 – 5.63; P < 0.001) and 9.66 % (95 %CI 9.61 – 9.71; P < 0.001), respectively. Conclusions RFA safely eradicates IM and dysplasia and reduces the rates of progression from LGD to HGD or cancer in the short term.

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Tu1142 Marginal Increase in Dysplasia Detection and Very High False Positive Rate for Volumetric Laser Endomicroscopy in Barrett's Esophagus: Systemic Review and Meta-Analysis

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2017.03.1279 ◽

2017 ◽

Vol 85 (5) ◽

pp. AB554 ◽

Cited By ~ 5

Author(s):

Bashar J. Qumseya ◽

Sherif Gendy ◽

Yazen Qumsiyeh ◽

Paul Bain ◽

Amira Qumseya ◽

...

Keyword(s):

Barrett’S Esophagus ◽

False Positive ◽

Barrett's Esophagus ◽

Meta Analysis ◽

False Positive Rate ◽

Systemic Review ◽

Marginal Increase ◽

High False Positive Rate ◽

Positive Rate ◽

Very High

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Liquid nitrogen spray cryotherapy-based multimodal endoscopic management of dysplastic Barrett’s esophagus and early esophageal neoplasia: retrospective review and long-term follow-up at an academic tertiary care referral center

Diseases of the Esophagus ◽

10.1093/dote/doz095 ◽

2020 ◽

Vol 33 (4) ◽

Cited By ~ 1

Author(s):

Vivek Kaul ◽

Krystle Bittner ◽

Asad Ullah ◽

Shivangi Kothari

Keyword(s):

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Tertiary Care ◽

Secondary Outcome ◽

Segment Length ◽

Single Center ◽

Esophageal Neoplasia ◽

Complete Eradication

Summary Background Endoscopic eradication therapy of dysplastic Barrett’s esophagus (BE) and early esophageal neoplasia has emerged as an effective treatment option. Data for the role of spray cryotherapy (SCT) in this setting is relatively limited. Objective To evaluate the safety and long-term outcomes of SCT-based multimodal therapy in the management of dysplastic BE and early esophageal neoplasia. Design Single-center, retrospective, cohort study. Setting Academic, tertiary care center between August 2008 and February 2019. Methods A retrospective chart review was conducted of the prospectively maintained endoscopic cryotherapy database at our center. Fifty-seven patients were identified who underwent SCT treatment for dysplastic BE and esophageal or Gastro-esophageal (GE) junction adenocarcinoma during the study period. Primary outcome was complete eradication of intestinal metaplasia (CE-IM); secondary outcome was complete eradication of dysplasia (CE-D). Results A total of 171 SCT procedures were performed in 57 patients. The majority of patients were male (89.5%) with long-segment BE (93%; mean segment length 6.2 cm). Complete follow-up data was available for 56 of these 57 patients. 43.9% (25/57) of patients underwent radiofrequency ablation (RFA) during the course of treatment (e.g. after initiating SCT). 33.3% of patients (19/57) were RFA failures prior to SCT. Additionally, 68.4% (39/57) of patients underwent endoscopic resection (EMR) prior to SCT as part of our multimodal approach to treatment of BE dysplasia/neoplasia. Four patients (7%) are currently undergoing active ablation and/or EMR treatment. CE-IM was achieved in 75% (39/52) of patients, and CE-D in 98.1% (51/52). Mean duration of overall follow-up was 4.8 years, with mean CE-IM durability of 2.6 years. Limitations Single-center only, retrospective study design. Conclusion SCT-based multimodal endoscopic therapy can achieve very high CE-IM (75%) and CE-D (>98%) rates in a high-risk population with esophageal dysplasia and/or neoplasia.

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Esophageal abnormalities and the risk for gastroesophageal cancers—a histopathology-register-based study in Sweden

European Journal of Epidemiology ◽

10.1007/s10654-021-00833-6 ◽

2022 ◽

Author(s):

Isabella Ekheden ◽

Jonas F. Ludvigsson ◽

Li Yin ◽

Peter Elbe ◽

Weimin Ye

Keyword(s):

General Population ◽

Confidence Interval ◽

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Population Based ◽

Low Grade ◽

Gastric Cardia Adenocarcinoma ◽

Increased Risk ◽

Columnar Metaplasia

Abstract Background The poor survival of patients with gastroesophageal cancers may improve if additional esophageal precursor lesions to Barrett’s esophagus and squamous dysplasia are identified. We estimated the risk for gastroesophageal cancers among patients with various histopathological abnormalities in the esophagus, including Barrett’s esophagus, subdivided by histopathological types. Methods Histopathology data from esophageal biopsies obtained 1979–2014 were linked with several national population-based registers in Sweden. Patients were followed from 2 years after the first biopsy date until cancer, death, emigration, esophagectomy/gastrectomy or end of follow-up, 31st of December 2016, whichever came first. We estimated standardized incidence ratios (SIRs) as measures of relative risk with the Swedish general population as reference. Results In total 367 esophageal adenocarcinoma (EAC) cases were ascertained during 831,394 person-years of follow-up. The incidence rate (IR) for EAC was 0.1 per 1000 person-years for normal morphology, 0.2–0.5 for inflammatory changes, and 0.8–2.9 for metaplasia. The IR was 1.0 per 1000 person-years (95% confidence interval 0.7–1.3) among patients with non-dysplastic intestinal metaplasia, 0.9 (0.8–1.1) in non-dysplastic gastric/glandular metaplasia and 2.9 (2.0–4.2) among columnar metaplasia patients with low-grade dysplasia. The SIRs were 11.7 (95% confidence interval 8.6–15.5), 12.0 (10.0–14.2) and 30.2 (20.5–42.8), respectively. The SIRs for gastric cardia adenocarcinoma (GCA) were moderately elevated. Conclusions For the first time, we demonstrate that patients with esophageal inflammatory and other metaplastic abnormalities than Barrett’s esophagus have an increased risk of EAC and GCA compared to the general population. Moreover, patients with different histopathologic subtypes of Barrett’s esophagus have a comparable risk for EAC.

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