Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Gastrointest Endosc. 2017 Oct;86(4):626-632. doi: 10.1016/j.gie.2017.02.006. Epub 2017 Feb 21.
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.
The aim of this study was to assess the efficacy, durability, and rate of neoplastic progression after LNSCT in BE-HGD/IMC at 3 and 5 years.
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 IMC completely removed by endoscopic resection were included. Outcome measures included complete eradication of HGD (CE-HGD), dysplasia, and intestinal metaplasia; incidence rates; durability of response; location of recurrent intestinal metaplasia and dysplasia; and rate of disease progression.
A total of 50 and 40 patients were included in 3-year and 5-year analyses. Initial CE-HGD, dysplasia, and intestinal metaplasia achieved in 98%, 90%, and 60%, respectively. Overall CE-HGD, dysplasia, and intestinal metaplasia 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). Incidence rates of recurrent intestinal metaplasia, dysplasia, and HGD/esophageal adenocarcinoma per person-year of follow-up after initial complete eradication of intestinal metaplasia (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.
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.
液氮喷雾冷冻疗法（LNSCT）已被证明是一种安全、耐受良好且有效的 Barrett 食管（BE）相关高级别异型增生（BE-HGD）和黏膜内腺癌（IMC）的治疗方法。目前缺乏长期随访数据。
本研究旨在评估 LNSCT 治疗 BE-HGD/IMC 后 3 年和 5 年时的疗效、持久性和肿瘤进展率。
本研究为单中心回顾性研究，来自前瞻性数据库，纳入接受 LNSCT 治疗的任意长度 BE-HGD/IMC 患者，通过内镜监测活检进行 3 至 5 年的随访。内镜完全切除 IMC 的患者也纳入本研究。主要终点包括完全消除异型增生（CE-HGD）、异型增生和肠化生；发生率；反应持久性；复发性肠化生和异型增生的位置；以及疾病进展率。
分别有 50 例和 40 例患者纳入 3 年和 5 年分析。初始时，CE-HGD、异型增生和肠化生的完全消除率分别为 98%、90%和 60%。3 年时的总 CE-HGD、异型增生和肠化生率分别为 96%（48/50）、94%（47/50）和 82%（41/50），5 年时分别为 93%（37/40）、88%（35/40）和 75%（30/40）。在初始肠化生完全消除（CE-IM）后，每 1 人年的复发性肠化生、异型增生和 HGD/食管腺癌的发生率分别为 12.2%、4.0%和 1.4%，这是 5 年队列的结果。大多数复发发生在新的鳞状柱状交界的下方。7 例异型增生复发病例中有 2 例发生在初始消除后 4 年以上，2 例（4%）患者尽管进行了治疗但进展为腺癌。
在 BE-HGD/IMC 患者中，LNSCT 可有效消除异型增生和肠化生。腺癌进展并不常见，大多数病例中异型增生的复发均可得到成功治疗。需要进行长期监测以发现异型增生的迟发性复发。
