Overwater Anouk, Weusten Bas L A M
aDepartment of Gastroenterology & Hepatology, St. Antonius Hospital, Nieuwegein bDepartment of Gastroenterology & Hepatology, University Medical Center, Utrecht, The Netherlands.
Curr Opin Gastroenterol. 2017 Jul;33(4):261-269. doi: 10.1097/MOG.0000000000000372.
Providing an overview on types of cryotherapy for esophageal application and their role in the management of Barrett's esophagus.
Recent studies have involved multiple types of cryotherapy including cryospray techniques that use either liquid nitrogen or carbon dioxide as the cryogenic fluid, and the CryoBalloon focal ablation device that uses nitrous oxide. Overall, studies report cryotherapy to be safe and effective in eradicating Barrett's epithelium. However, substantial variations among these studies in design and outcomes preclude direct comparisons of the results. Moreover, little is known of the long-term outcomes of cryotherapy, with only one report describing 5-year follow-up of patients treated with liquid nitrogen cryospray.
The concept of cryotherapy is appealing. By preserving the extracellular matrix and inducing anesthetic effects, cryotherapy has the potential to enable deeper ablations with less pain and a lower rate of stricture formation than radiofrequency ablation. To date, however, these potential benefits remain unproved. Prospective studies with clearly defined endpoints and longer follow-up are necessary to determine the role of cryotherapy in the management of patients with Barrett's esophagus.
概述用于食管的冷冻疗法类型及其在巴雷特食管管理中的作用。
近期研究涉及多种冷冻疗法，包括使用液氮或二氧化碳作为低温流体的冷冻喷雾技术，以及使用一氧化二氮的冷冻球囊聚焦消融装置。总体而言，研究报告称冷冻疗法在根除巴雷特上皮方面安全有效。然而，这些研究在设计和结果上存在很大差异，无法直接比较结果。此外，对于冷冻疗法的长期结果知之甚少，仅有一份报告描述了接受液氮冷冻喷雾治疗患者的5年随访情况。
冷冻疗法的概念很有吸引力。通过保留细胞外基质并产生麻醉效果，冷冻疗法有可能实现比射频消融更深的消融，且疼痛更少、狭窄形成率更低。然而，迄今为止，这些潜在益处尚未得到证实。需要进行具有明确终点和更长随访期的前瞻性研究，以确定冷冻疗法在巴雷特食管患者管理中的作用。
