Liquid Nitrogen Spray Cryotherapy is Associated With Less Postprocedural Pain Than Radiofrequency Ablation in Barrett's Esophagus A Multicenter Prospective Study
Liquid Nitrogen Spray Cryotherapy is Associated With Less Postprocedural Pain Than Radiofrequency Ablation in Barrett's Esophagus A Multicenter Prospective Study
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DOI：
10.1097/mcg.0000000000000999
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发表时间：
2019-02-01
影响因子：
2.9
通讯作者：
Trindade, Arvind J.
中科院分区：
文献类型：
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作者：
Solomon, Sanjeev S.;Kothari, Shivangi;Trindade, Arvind J.
目标和背景：两种常见的内镜治疗根治异型增生巴雷特食管射频消融（RFA）和液氮喷雾冷冻治疗（LNC）。没有比较术后疼痛的数据。本研究旨在比较两种消融方式之间术后疼痛的发生率。方法：这是一项多中心前瞻性研究，在治疗前和治疗后即刻、治疗后48小时和治疗后3周使用经验证的仪器评估疼痛强度评分和吞咽困难的存在。结果：在94例患者中，35例接受了LNC，59例接受了RFA [36例采用局灶性射频消融（RFA-F），23例采用环周射频消融（RFA-C）]。治疗后即刻，LNC组患者报告的平均数字疼痛量表评分低于RFA组[LNC 0.41 vs. RFA-F 1.18（P=0.026），LNC 0.41 vs. RFA-C 1.38（P=0.010）]。这些差异持续到治疗后48小时[LNC 0.76 vs. RFA-F 1.77（P=0.013），LNC 0.76 vs. RFA-C 1.73（P=0.018）]。RFA后疼痛的几率至少是LNC后的5倍[治疗后即刻的比值比，5.26（95%置信区间，1.85-14.29）和治疗后48小时的比值比，5.56（95%置信区间，2.27-14.29）]。在任何时间点，两组治疗后吞咽困难均无差异（P=0.429）。结论：与RFA相比，LNC术后疼痛较少。这些结果有助于告知患者和医生有关消融性内镜治疗后的预期症状。
Goals and Background: Two common endoscopic therapies for eradication of dysplastic Barrett's esophagus are radiofrequency ablation (RFA) and liquid nitrogen spray cryotherapy (LNC). There is no data comparing postprocedural pain. This study aimed to compare the incidence of postprocedural pain between the 2 ablation modalities.Methods: This is a multicenter prospective study in which pain intensity scores and the presence of dysphagia were assessed immediately before and after treatment, 48 hours posttreatment and at 3 weeks posttreatment using validated instruments.Results: Of 94 patients, 35 underwent LNC and 59 underwent RFA [36 with focal radiofrequency ablation (RFA-F) and 23 with circumferential radiofrequency ablation (RFA-C)]. Immediately posttreatment, patients in the LNC group reported an average Numeric Pain Scale score that was lower than in the RFA groups [LNC 0.41 vs. RFA-F 1.18 (P=0.026), LNC 0.41 vs. RFA-C 1.38 (P=0.010)]. These differences persisted at 48 hours posttreatment [LNC 0.76 vs. RFA-F 1.77 (P=0.013), LNC 0.76 vs. RFA-C 1.73 (P=0.018)]. The odds of pain after RFA were at least 5 times greater than after LNC [immediately posttreatment odds ratio, 5.26 (95% confidence interval, 1.85-14.29) and 48 h posttreatment odds ratio, 5.56 (95% confidence interval, 2.27-14.29)]. There was no difference in dysphagia after treatment in either group, at any time point (P=0.429).Conclusion: LNC was associated with less postprocedural pain when compared with RFA. These results help inform patients and physicians about the expected symptoms after ablative endotherapy.