Focal cryoballoon versus radiofrequency ablation of dysplastic Barrett's esophagus: impact on treatment response and postprocedural pain
Focal cryoballoon versus radiofrequency ablation of dysplastic Barrett's esophagus: impact on treatment response and postprocedural pain
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DOI：
10.1016/j.gie.2018.06.015
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发表时间：
2018-11-01
影响因子：
7.7
通讯作者：
Weusten, Bas L. A. M.
中科院分区：
文献类型：
--
作者：
van Munster, Sanne N.;Overwater, Anouk;Weusten, Bas L. A. M.
背景和目的：射频消融（RFA）对于根除巴雷特食管（BE）是安全有效的，但会带来明显的术后疼痛。另外，最近开发了基于球囊的局部冷冻消融术（CRYO），它可以保留细胞外基质，因此可能减轻疼痛。尽管 CRYO 的数据仍然有限，但非对照研究表明，在消除有限的 BE 区域方面，CRYO 的安全性和有效性与 RFA 相当。因此，次要终点（例如疼痛）可能成为治疗选择的决定性因素。我们的目的是比较局部 CRYO 和 RFA 之间的疗效和耐受性。方法：我们从荷兰 2 个转诊中心的前瞻性队列中确定了对所有可见 BE 进行局部消融（RFA 或 CRYO）的 BE 患者。消融后，患者完成 14 天的数字日记，以评估胸痛 (0-10)、吞咽困难 (0-4) 和镇痛药的使用情况。 3 个月后计划进行后续内窥镜检查，以评估 BE 表面退化（由 2 名独立 BE 专家内窥镜师盲法评分）。结果是BE表面回归；疼痛、吞咽困难、镇痛药和峰值疼痛的 14 天累积评分（曲线下面积 [AUC]）。结果：我们确定了 46 名具有相似基线特征的患者（20 名 CRYO，26 名 RFA）。 BE 回归具有可比性（88% 与 90%，P = .62）。 CRYO 治疗后疼痛、吞咽困难和镇痛药的 AUC 显着小于 RFA（所有 P < .01）。 CRYO 后峰值疼痛较低（视觉模拟评分 2 vs 4，P < .01），CRYO 后疼痛持续时间也较短（2 vs 4 天，P < .01）。 CRYO 患者使用镇痛药 2 天，而 RFA 则使用 4 天 (P < .01)。结论：在这项多中心、非随机队列研究中，我们发现 CRYO 和 RFA 单次治疗短节段 BE 的疗效没有差异。与 RFA 相比，患者报告 CRYO 后疼痛减轻。此外，CRYO 患者使用的镇痛药较少。我们的结果表明，与 RFA 相比，CRYO 的疼痛过程有所不同，但需要进行随机试验才能得出明确的结论。
Background and Aims: Radiofrequency ablation (RFA) is safe and effective for eradicating Barrett's esophagus (BE) but is associated with significant postprocedural pain. Alternatively, balloon-based focal cryoablation (CRYO) has recently been developed, which preserves the extracellular matrix and might therefore be less painful. Although data for CRYO are still limited, uncontrolled studies suggest comparable safety and efficacy to RFA in eradicating limited BE areas. Therefore, secondary endpoints such as pain might become decisive for treatment selection. We aimed to compare efficacy and tolerability between focal CRYO and RFA.Methods: We identified BE patients undergoing focal ablation (either RFA or CRYO) of all visible BE from our prospective cohort in 2 Dutch referral centers. After ablation, patients completed a 14-day digital diary to assess chest pain (0-10), dysphagia (0-4), and analgesics use. A follow-up endoscopy was scheduled after 3 months to assess the BE surface regression (blindly scored by 2 independent BE expert endoscopists). Outcomes were BE surface regression; 14-day cumulative scores (area under the curves [AUCs]) for pain, dysphagia, analgesics, and peak pain.Results: We identified 46 patients (20 CRYO, 26 RFA) with similar baseline characteristics. The BE regression was comparable (88% vs 90%, P = .62). AUCs for pain, dysphagia, and analgesics were significantly smaller after CRYO versus RFA (all P < .01). Peak pain was lower after CRYO (visual analog scale 2 vs 4, P < .01), and the duration of pain was also shorter after CRYO (2 vs 4 days, P < .01). CRYO patients used analgesics for 2 days versus 4 days for RFA (P < .01).Conclusions: In this multicenter, nonrandomized cohort study, we found no differences in efficacy after a single treatment with CRYO and RFA for short-segment BE. Patients reported less pain after CRYO as compared with RFA. Moreover, CRYO patients used fewer analgesics. Our results suggest a different pain course favoring CRYO over RFA, but a randomized trial is needed for definitive conclusions.