Outcomes after liquid nitrogen spray cryotherapy in Barrett's esophagus-associated high-grade dysplasia and intramucosal adenocarcinoma: 5-year follow-up.

Related Articles

Outcomes after liquid nitrogen spray cryotherapy in Barrett's esophagus-associated high-grade dysplasia and intramucosal adenocarcinoma: 5-year follow-up.

Gastrointest Endosc. 2017 Feb 21;:

Authors: Ramay FH, Cui Q, Greenwald BD

Abstract
BACKGROUND: Liquid nitrogen spray cryotherapy (LNSCT) has been shown to be a safe, well-tolerated, and effective therapy for Barrett's esophagus (BE)-associated high grade dysplasia (BE-HGD) and intramucosal adenocarcinoma (IMC). Long-term follow-up is lacking.
AIMS: The authors' aim was to assess the efficacy, durability, and rate of neoplastic progression after LNSCT in BE-HGD/IMC at 3 and 5 years.
METHODS: In this single-center, retrospective study drawn from a prospective database, patients with BE-HGD/IMC of any length treated with LNSCT were followed with surveillance endoscopy with biopsy for 3 to 5 years. Patients with intramucosal adenocarcinoma completely removed by endoscopic resection were included. Outcome measures included complete eradication of HGD (CE-HGD), dysplasia (CE-D), and intestinal metaplasia (CE-IM), incidence rates (IR), durability of response, location of recurrent IM and dysplasia, and rate of disease progression.
RESULTS: 50 and 40 patients were included in 3-year and 5-year analyses. Initial CE-HGD, CD-D, and CE-IM were achieved in 98%, 90%, and 60%, respectively. Overall CE-HGD, CE-D, and CE-IM at 3 years were 96% (48/50), 94% (47/50), and 82% (41/50), and at 5 years were 93% (37/40), 88% (35/40), and 75% (30/40). IRs of recurrent IM, dysplasia, and HGD/esophageal adenocarcinoma per person-year of follow-up after initial CE-IM were 12.2%, 4.0%, and 1.4% per person-year for the 5-year cohort. Most recurrences were found immediately below the neosquamocolumnar junction. Two of 7 HGD recurrences occurred later than 4 years after initial eradication, and 2 patients (4%) progressed to adenocarcinoma despite treatment.
CONCLUSION: In patients with BE-HGD/IMC, LNSCT is effective in eliminating dysplasia and intestinal metaplasia. Progression to adenocarcinoma was uncommon, and recurrence of dysplasia was successfully treated in most cases. Long-term surveillance is necessary to detect late recurrence of dysplasia.

PMID: 28235596 [PubMed - as supplied by publisher]

} http://ift.tt/2m1U9NP


http://ift.tt/2mCwuQv