Salvage Cryotherapy for Treatment of Persistent Barrett’s Esophagus

Abstract

Background: A dysplastic Barrett’s esophagus can lead to cancer if not treated by endoscopic
eradication therapy. The current consensus is to eradicate the entire residual Barrett’s esophagus
that is visible during endoscopy by ablation therapy. However, a section of patients are
resistant to this ablation therapy. They may need a second line of ablation therapy to eradicate
the visible residual Barrett’s esophagus.
Aims: To evaluate the efficacy of treatment with salvage cryotherapy of persistent Barrett’s
esophagus who failed to respond for ablation by radio frequency ablation.
Methods: Barrett’s esophagus with high-grade dysplasia was initially treated with radiofrequency
ablation (RFA) for at least 6 sessions to achieve complete eradication of Barrett’s
esophagus. Barrett’s esophagus patients who failed to respond to the radiofrequency ablation
was then treated with a different ablation therapy modality like a cryotherapy to achieve complete
eradication of Barrett’s esophagus.
Results: Two patients with Barrett’s esophagus and high-grade dysplasia were included in the
case series. The Barrett’s esophagus in both the patients was treated with a mean of 6.5 sessions
of radiofrequency ablation. Both the patients had persistent Barrett’s esophagus despite the
treatment with radiofrequency ablation as demonstrated by surveillance endoscopic biopsies.
They were then treated with a mean of 4.5 sessions of cryotherapy as a salvage therapy. Surveillance
endoscopy showed persistent Barrett’s esophagus in both the patients despite being
treated with cryotherapy. None of the patients had high-grade dysplasia in the surveillance
endoscopy.
Conclusion: Salvage cryotherapy is futile in persistent Barrett’s esophagus that had prior treatment
failure with a different ablation therapy.