Cryotherapy or cryoablation involves the freezing of tissues to destroy unwanted tissue or to control bleeding. Endoscopic cryotherapy has been developed for gastrointestinal application by through-the-scope noncontact delivery of compressed carbon dioxide gas or liquid nitrogen (cryospray) or contact balloon cryoablation. The mechanism of cryotherapy ablative effects includes immediate injury as well as coagulation necrosis occurring over several hours and days, unlike heat-based thermal ablation. This article reviews the basis, technique, safety, efficacy, and durability for the use of endoscopic cryotherapy in Barrett’s esophagus and esophageal adenocarcinoma.
Key points
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Current cryotherapy systems allow endoscopic application of freezing energy to esophageal tissue by either “spray” or contact balloon method, with resulting mucosal necrosis evolving over several days.
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The accumulating albeit small number of studies suggests that cryotherapy is a safe and effective technique for eradication of Barrett’s esophagus and associated neoplasia, with or without prior endoscopic mucosal resection of lesions. It may successfully eradicate Barrett’s esophagus even in patients who have prior failed therapy, including radiofrequency ablation.
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The data supporting the use of endoscopic cryotherapy in clinical practice are limited to retrospective cohort studies and a prospective registry study. Prospective large clinical trials are needed.
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