Long-Term Outcomes of Nitrous Oxide Cryoballoon Ablation of Barrett’s Esophagus-Associated Early Adenocarcinoma After Attempted Curative Endoscopic Mucosal Resection

Abstract

Objective: Nitrous oxide cryoballoon ablation (CBA) is an effective therapy for Barrett’s esophagus (BE). Data regarding the efficacy of CBA for complete eradication of BE-associated intramucosal adenocarcinoma (ImCA) after endoscopic mucosal resection (EMR) are limited. Our aim is to determine the eradication rates of CBA for ImCA after unsuccessful attempted EMR. Methods: In this retrospective study we analyzed data from the electronic medical record of patients with ImCA who were treated with CBA as primary or rescue ablative therapy at a tertiary care academic center between July 2014 and September 2022. The primary outcome was complete eradication of ImCA (CE-CA). Secondary outcomes included eradication rate of intestinal metaplasia, recurrence rate of cancer and intestinal metaplasia, cancer-related morality, and disease-specific survival. Results: Thirty-five patients were included in the study. Group 1: 23 patients with EMR with positive margins. Group 2: 12 patients with unlocalized biopsy-proven ImCA. The median pre-CBA Prague C and M were 2 cm (SD ± 3.6) and 4.0 cm (SD ± 4). 21 (91%) patients in Group 1 achieved CE-CA within 1 year after a median 3 (IQR 2) CBA sessions. BE-CA related mortality was zero. There were no cases of recurrent intraluminal or extraluminal CA. 32 patients achieved and maintained CE-CA, while 23 (65.7%) achieved CE-IM by year 1. Conclusion: In our cohort, CBA was safe and effective for cancer and intestinal metaplasia eradication up to 5 years from initial treatment. Prospective studies are needed to assess the role of CBA in endoscopic therapy of early esophageal cancer.