Feasibility of liquid nitrogen cryotherapy after failed radiofrequency ablation for Barrett's esophagus
Feasibility of liquid nitrogen cryotherapy after failed radiofrequency ablation for Barrett's esophagus
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DOI：
10.1111/den.12869
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发表时间：
2017-09-01
影响因子：
5.3
通讯作者：
Kaul, Vivek
中科院分区：
文献类型：
--
作者：
Trindade, Arvind J.;Inamdar, Sumant;Kaul, Vivek
背景和目的射频消融 (RFA) 对于发育不良的巴雷特食管 (BE) 非常有效。 RFA 失败的情况很少见，但管理起来可能具有挑战性。关于 RFA 未能在不典型增生 BE 患者中实现 CE-IM 后，液氮冷冻喷雾消融彻底根除不典型增生 (CE-D) 和/或肠化生 (CE-IM) 的可行性数据有限。方法这是对两个医疗中心的前瞻性维护数据库进行的回顾性审查，研究了在 RFA 失败后接受液氮冷冻喷雾消融治疗难治性肠化生的患者。结果确定 18 名患者符合纳入标准标准。 RFA 后，11 名患者出现持续性不典型增生和 IM，7 名患者出现持续性非不典型增生 IM。超过80%的患者为长节段BE（中位长度8cm）的男性。 72% 的不典型增生患者在冷冻治疗后达到 CE-D。所有 RFA 失败的百分之五十 (9/18) 通过冷冻疗法实现了 CE-IM。相比之下，根据对 3802 名患者进行的大规模荟萃分析，在挑战性较小的初次治疗队列中，RFA 的 CE-IM 为 78%。我们的队列中没有发生不良事件。结论冷冻喷雾消融对于在 RFA 失败后实现 CE-D 和 CE-IM 是可行且安全的。冷冻疗法在该人群中的 CE-D 率很高。与未接受过发育不良 BE 治疗的患者的 CE-IM 联合 RFA 率相比，CE-IM 联合冷冻疗法在这一难以治疗的队列中是可以接受的（50% vs 78%）。
Background and AimRadiofrequency ablation (RFA) for dysplastic Barrett's esophagus (BE) is highly effective. RFA failures are infrequent but can be a challenging cohort to manage. There are limited data on the feasibility of liquid nitrogen cryospray ablation for complete eradication of dysplasia (CE-D) and/or intestinal metaplasia (CE-IM) after RFA has failed to achieve CE-IM in patients with dysplastic BE.MethodsThis is a retrospective review from two medical centers of prospectively maintained databases looking at patients that underwent liquid nitrogen cryospray ablation for refractory intestinal metaplasia post failed RFA.ResultsEighteen patients were identified that met inclusion criteria. Eleven patients had persistent dysplasia and IM following RFA and seven had persistent non-dysplastic IM. More than 80% of patients were male with long-segment BE (median length 8cm). Seventy two percent of patients with dysplasia achieved CE-D after cryotherapy. Fifty percent (9/18) of all RFA failures achieved CE-IM with cryotherapy. In comparison, RFA has a CE-IM of 78% in a less challenging treatment naive cohort from a large-scale meta-analysis of 3802 patients. No adverse events occurred in our cohort.ConclusionCryospray ablation is feasible and safe for achieving CE-D and CE-IM after RFA failure. The CE-D rates are high with cryotherapy in this population. CE-IM with cryotherapy is acceptable in this difficult-to-treat cohort when compared to CE-IM rates with RFA in dysplastic BE treatment naive patients (50% vs 78%).