Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Gastrointest Endosc. 2013 Aug;78(2):260-5. doi: 10.1016/j.gie.2013.03.002. Epub 2013 Apr 24.
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.
To assess the long-term safety and efficacy of spray cryotherapy in patients with BE-HGD.
Single-center, retrospective study.
Tertiary-care referral center.
A total of 32 patients with BE-HGD of any length.
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 was performed for at least 2 years.
CE-HGD, CE-IM, durability of response, disease progression, and adverse events.
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.
Retrospective study design, small sample size.
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.
液氮内镜喷雾冷冻疗法可安全有效地根除 Barrett 食管（BE）的高级别异型增生（HGD）。目前缺乏长期的治疗成功率和安全性数据。
评估 BE-HGD 患者接受喷雾冷冻治疗的长期安全性和疗效。
单中心、回顾性研究。
三级转诊中心。
共 32 例 BE-HGD 患者，病变长度不限。
患者每隔 8 周接受一次液氮喷雾冷冻治疗，直至通过内镜活检发现 HGD（CE-HGD）和肠上皮化生（CE-IM）完全根除。至少进行 2 年的监测性内镜检查和活检。
CE-HGD、CE-IM、应答持续时间、疾病进展和不良事件。
2 年随访时，CE-HGD 完全缓解率为 100%（32/32），CE-IM 为 84%（27/32）。末次随访（24-57 个月）时，CE-HGD 完全缓解率为 31/32（97%），CE-IM 为 26/32（81%）。5 例患者复发 HGD，经再次治疗后 CE-HGD 完全缓解。1 例患者进展为腺癌，经再次冷冻治疗后降级为 HGD。BE 段长度≥3 cm 与 IM 复发率较高相关（P=0.004；优势比 22.6），但与 HGD 无关。无严重不良事件发生。3 例（9%）患者出现狭窄，均成功扩张。
回顾性研究设计，样本量小。
在 BE-HGD 患者中，液氮内镜喷雾冷冻疗法根除 HGD 和 IM 的成功率较高，安全性可接受，且长期随访显示复发或进展为癌症的风险较低。
