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A novel cryoballoon ablation system for eradication of dysplastic Barrett's esophagus: a first-in-human feasibility study

van Munster, S. N., Overwater, A., Raicu, M. G. M., Seldenrijk, K. C. A., Nagengast, W. B., Schoon, E. J., Bergman, J. J. G. H. M. & Weusten, B. L. A. M., 2020, In : Endoscopy. 52, 3, p. 193-201 9 p.

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  • A novel cryoballoon ablation system for eradication of dysplastic Barrett's esophagus_ a first-in-human feasibility study

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DOI

  • Sanne Noortje van Munster
  • Anouk Overwater
  • Mihaela G M Raicu
  • Kees C A Seldenrijk
  • Wouter B Nagengast
  • Erik J Schoon
  • Jacques J G H M Bergman
  • Bas L A M Weusten

BACKGROUND:  Endoscopic cryoablation for Barrett's esophagus (BE) might offer advantages over heat-based ablation. Focal cryoballoon ablation has been promising for short-segment BE, whereas the novel 90°-swipe cryoballoon ablation system (CbSAS90) ablates larger areas in a single step (90° over 3 cm). The system allows for dose adjustment. CbSAS90 has been feasible and safe in animal and pre-esophagectomy studies. This is the first clinical study to assess feasibility, safety, and efficacy of CbSAS90 for eradication of dysplastic BE.

METHODS:  In this prospective study in dysplastic BE patients, dose finding started with semi-circumferential treatment at 0.8 mm/s (dose 1). The dose was escalated by reducing speed by 0.1 mm/s in six patients until BE surface regression was ≥ 80 % without complications ("effective dose"). The effective dose was subsequently confirmed with circumferential treatment in 12 new patients. Post-procedural pain (0 - 10) and dysphagia (0 - 4) were evaluated. Outcomes were feasibility, safety, and BE surface regression.

RESULTS:  25 patients were included, with technically successful treatment in 92 % (95 %CI 73 % - 99 %). Median (95 %CI) BE surface regression was 78 % (50 % - 85 %) for dose 1 and 85 % (55 % - 95 %) for dose 2 (0.7 mm/s), which was defined as the effective dose. Circumferential treatment resulted in 93 % (88 % - 96 %) regression. Two of 12 patients with circumferential treatment developed strictures that required dilation. Median pain and dysphagia scores were low (0 - 3 and 0, respectively).

CONCLUSIONS: CbSAS90 was feasible and effective for ablating larger BE areas. The optimal dose for circumferential treatment that balances safety and efficacy requires further evaluation.

Original languageEnglish
Pages (from-to)193-201
Number of pages9
JournalEndoscopy
Volume52
Issue number3
Publication statusPublished - 2020

ID: 119780700