Salvage Cryotherapy for Treatment of Persistent Barrett’s Esophagus

Abstract

Background: A dysplastic Barrett’s esophagus can lead to cancer if not treated by endoscopic eradication therapy. The current consensus is to eradicate the entire residual Barrett’s esophagus that is visible during endoscopy by ablation therapy. However, a section of patients are resistant to this ablation therapy. They may need a second line of ablation therapy to eradicate the visible residual Barrett’s esophagus.
Aims: To evaluate the efficacy of treatment with salvage cryotherapy of persistent Barrett’s esophagus who failed to respond for ablation by radio frequency ablation.

Methods: Barrett’s esophagus with high-grade dysplasia was initially treated with radiofrequency ablation (RFA) for at least 6 sessions to achieve complete eradication of Barrett’s esophagus. Barrett’s esophagus patients who failed to respond to the radiofrequency ablation was then treated with a different ablation therapy modality like a cryotherapy to achieve complete eradication of Barrett’s esophagus.
Results: Two patients with Barrett’s esophagus and high-grade dysplasia were included in the case series. The Barrett’s esophagus in both the patients was treated with a mean of 6.5 sessions of radiofrequency ablation. Both the patients had persistent Barrett’s esophagus despite the treatment with radiofrequency ablation as demonstrated by surveillance endoscopic biopsies. They were then treated with a mean of 4.5 sessions of cryotherapy as a salvage therapy. Surveillance endoscopy showed persistent Barrett’s esophagus in both the patients despite being treated with cryotherapy. None of the patients had high-grade dysplasia in the surveillance endoscopy.
Conclusion: Salvage cryotherapy is futile in persistent Barrett’s esophagus that had prior treatment failure with a different ablation therapy.