Johnston MH et al. (2005) Cryoablation of Barrett's esophagus: a pilot study. Gastrointest Endosc 62: 842–848

The only ablative modality currently approved by the FDA for treatment of Barrett's esophagus is photodynamic therapy, which is associated with adverse events such as chest pain and dysphagia. A safe, effective modality with minimal side effects is desirable. In this pilot study, Johnston et al. describe the use of a novel cryoablative device, using liquid nitrogen dispensed at a low pressure (13.7896–27.5792 kPa) through the accessory channel of an upper endoscope.

Of the 11 enrolled male patients (mean age 59 years) with Barrett's esophagus, 9 completed the treatment protocol, receiving an average of 3.6 treatments each (range 1–6). The other two withdrew for reasons not directly related to treatment. All patients received 40 mg rabeprazole three times daily during the treatment period. Cryoablation was applied to 4 cm segments, hemicircumferentially from the most proximal margin, for 20 s, the treated area permitted to thaw, and application repeated immediately. All patients underwent monthly follow-up endoscopy. Mean follow-up was 12 months (range 6–20 months).

Reversal of Barrett's esophagus was seen in all nine patients. Complete histological eradication of Barrett's esophagus was seen in seven patients at the 6-month follow-up; the other two patients had fragments of specialized intestinal metaplasia. No significant adverse events were reported.

Cryoablation is safe, easy to administer, and effective in the treatment of Barrett's esophagus. Although this was a small, uncontrolled, pilot study, the authors believe their success rate is cause for further investigation of the technique.