Alzoubaidi Durayd, Hussein Mohamed, Sehgal Vinay, Makahamadze Christwishes, Magee Cormac G, Everson Martin, Graham David, Sweis Rami, Banks Matthew, Sami Sarmed S, Novelli Marco, Lovat Laurence, Haidry Rehan
Division of Surgery and interventional science, University College London (UCL), London, UK.
Department of Gastroenterology, University College London Hospital (UCLH), London, UK.
Endosc Int Open. 2020 Jul;8(7):E891-E899. doi: 10.1055/a-1149-1414. Epub 2020 Jun 16.
Cryoablation with the Cryoballoon device is a novel ablative therapy that uses cycles of freezing and thawing to induce cell death. This single-center prospective study evaluated the feasibility of the focal cryoablation device for the treatment of areas of refractory esophageal neoplasia in patients who had undergone first line endoscopic eradication therapy (EET). Complete remission of dysplasia (CR-D) and complete remission of intestinal metaplasia (CR-IM) at first follow-up endoscopy, durability of disease reversal, rates of stenosis and adverse events were studied. Eighteen cases were treated. At baseline, nine patients had low-grade dysplasia (LGD), six had high-grade dysplasia (HGD) and three had intramucosal carcinoma (IMC). Median length of dysplastic Barrett's esophagus (BE) treated was 3 cm. The median number of ablations per patient was 11. Each selected area of visible dysplasia received 10 seconds of ablation. One session of cryoablation was performed per patient. Biopsies were performed at around 3 months post-ablation. CR-D was achieved in 78 % and CR-IM in 39 % of patients. There were no device malfunction or adverse events. Stenosis was noted in 11 % of cases. At a median follow up of 19-months, CR-D was maintained in 72 % of patients and CR-IM in 33 %. Cryoablation appears to be a viable rescue strategy in patients with refractory neoplasia. It is well tolerated and successful in obtaining CR-D and CR-IM in patients with treatment-refractory BE. Further trials of dosimetry, efficacy and safety in treatment-naïve patients are underway.
使用冷冻球囊装置进行冷冻消融是一种新型的消融疗法，它利用冷冻和解冻循环来诱导细胞死亡。这项单中心前瞻性研究评估了聚焦冷冻消融装置用于治疗接受一线内镜根除治疗（EET）的难治性食管肿瘤患者的可行性。研究了首次随访内镜检查时发育异常的完全缓解（CR-D）和肠化生的完全缓解（CR-IM）、疾病逆转的持久性、狭窄率和不良事件。共治疗了18例患者。基线时，9例患者为低级别发育异常（LGD），6例为高级别发育异常（HGD），3例为黏膜内癌（IMC）。接受治疗的发育异常巴雷特食管（BE）的中位长度为3厘米。每位患者的消融中位数为11次。每个选定的可见发育异常区域接受10秒的消融。每位患者进行一次冷冻消融治疗。在消融后约3个月进行活检。78%的患者实现了CR-D，39%的患者实现了CR-IM。未发生设备故障或不良事件。11%的病例出现狭窄。在中位随访19个月时，72%的患者维持了CR-D，33%的患者维持了CR-IM。冷冻消融似乎是难治性肿瘤患者可行的挽救策略。它耐受性良好，在治疗难治性BE患者中成功获得了CR-D和CR-IM。针对未经治疗患者的剂量学、疗效和安全性的进一步试验正在进行中。
