JDDH Journal

Abstract

Background: Radiofrequency ablation (RFA) and Spray Cryotherapy (CRYO) are the two most used modalities to eradicate dysplasia and intestinal metaplasia in patients with dysplastic Barrett’s esophagus (BE) and reduce rates of esophageal adenocarcinoma. To date, no available RCTs to compare the efficacy of both modalities. Herein, we present a retrospective analysis in which we assessed the change in Prague classification and pathology after treatment, duration of individual procedures (minutes), the entire duration of treatment (weeks), and charges per procedure. Number of treatments needed to achieve eradication of BE and complications. Methods: Retrospective cohort study of all patients who underwent endoscopic eradication therapy for dysplastic BE at Marshall University School of Medicine from January 2019 to October 2022. Initial recognition of BE based on finding more than 1 cm length salmon patched mucosa using white light and Narrow Band imaging (NBI). Diagnosis of Dysplastic BE was established using cold forceps biopsy results after initial diagnostic endoscopy using Seattle Protocol. Tissue dysplasia in biopsies were confirmed by at least two pathologists with expertise in gastrointestinal pathology.  Follow up endoscopy to evaluate the resolution of BE by using white light endoscopy, Narrow Band Imaging (NBI), and tissue biopsy. Results: A total of 26 met the inclusion criterion. The RFA group included 19 patients, while the cryotherapy group included seven. 80.8% of patients were white males. The median age was 73.0 years (IQR: 63.0-79.5) and 69.0 (IQR: 51.0-74.5) for the cryotherapy and RFA groups, respectively. The median circumferential extent of Barrett’s was 5.0 cm (IQR: 4.0-15.0), and 10.00 (IQR 2.00, 15.00) in CRYO and RFA respectively before treatment.   The median marginal extent of 12.0 cm (IQR: 8.5-16.0) and 10.00 (IQR 3.00, 15.00) for CRYO and RFA respectively. Post treatment median circumferential extent of Barrett’s was 0 in the two groups. 21% of patients developed strictures in RFA group. Follow pathology biopsy after resolution of BE using NBI light showed complete eradication of dysplasia and / or intra-mucosal cancer (IMC). Post treatment strictures were more in RFA group (21%). Cost per treatment session was significantly lower in CRYO group. Duration of procedures and overall duration of treatment is significantly lower in RFA group. Conclusion: Both RFA and cryotherapy are effective endoscopic treatment modalities used to achieve complete eradication of dysplastic BE and intra mucosal cancer. No significant difference was found in the rates of improvement of Prague criteria and eradication of dysplasia and/or intra mucosal cancer (IMC). Strictures are more associated with RFA. Large cost difference was noted between CRYO and RFA per session. However, an increased procedure time and overall treatment duration was noted in the cryotherapy group.

Keywords: Barrett’s esophagus (BE); Radio Frequency Ablation (RFA); Spray Cryotherapy (CRYO); Low grade dysplasia (LGD); High grade dysplasia (HGD); intra mucosal cancer (IMC) Complete eradication of dysplasia (CRD); Complete eradication of Metaplasia (CRIM).