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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(11): E1462-E1473
DOI: 10.1055/a-1906-4967
Original article

Safety and efficacy of liquid nitrogen spray cryotherapy in Barrett’s neoplasia – a comprehensive review and meta-analysis

Saurabh Chandan
 1   Division of Gastroenterology & Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, United States
,
Jay Bapaye
 2   Department of Internal Medicine, Rochester General Hospital, Rochester, New York, New York, United States
,
Shahab R. Khan
 3   Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Smit Deliwala
 4   Internal Medicine, Hurley Medical Center, Flint, Michigan, United States
,
Babu P. Mohan
 5   Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
,
Daryl Ramai
 5   Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
,
Banreet S. Dhindsa
 6   Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
,
Hemant Goyal
 7   Department of Gastroenterology, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, Unites States
,
Lena L. Kassab
 8   Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States
,
Muhammad Aziz
 9   Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio, United States
,
Faisal Kamal
10   Division of Gastroenterology, University of California-San Francisco, California, United States
,
Antonio Facciorusso
11   Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
,
Douglas G. Adler
12   Center for Advanced Therapeutic Endoscopy (CATE), Centura Health, Porter Adventist Hospital, Denver, Colorado, United States
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Abstract

Background and study aims Barrett’s esophagus (BE) is a precursor condition to esophageal adenocarcinoma (EAC), resulting in transformation of the squamous epithelium of distal esophagus to columnar-lined epithelium with intestinal metaplasia (IM). Liquid nitrogen spray cryotherapy (LNSC) is a non-contact method of BE eradication and has been used both as primary and salvage therapy. We conducted a systematic review and meta-analysis to assess the safety and efficacy of LNSC.

Methods We searched multiple databases from inception through December 2021 to identify studies on use of LNSC for Barrett’s neoplasia. Pooled estimates were calculated using random-effects model and results were expressed in terms of pooled proportions with relevant 95 % confidence intervals (CIs) of complete eradication (CE) of dysplasia(D), high grade dysplasia (HGD) and IM.

Results Fourteen studies with 707 patients were included in our final analysis. Overall pooled rates of CE-D, CE-HGD and CE-IM were 80.8 % (CI 77.4–83.8; I2 62), 90.3 % (CI 85.2–93.7; I2 33) and 55.8 % (CI 51.7–59.8; I2 73) with follow up ranging from 4.25 months to 69.7 months. In patients with follow up beyond 24 months, the rates of CE-D and CE-IM were 83.6 % (CI 77.6–88.2; I2 60) and 54.7 % (CI 47.6–61.6; I2 81). Among LNSC naïve patients with prior history of endoscopic resection, the rates were 79.9 % (CI 73.3–85.2; I2 50) and 67.1 % (CI 59.5–73.8; I2 0). Pooled rate of therapeutic failures, defined as lack of response to LNSC therapy, was 23.6 % (CI 19.4–28.3; I2 73). Post LNSC strictures and perforation pooled rates were 4 % and 0.8 %, respectively, which are similar to those previously reported for RFA.

Conclusions Our analysis suggests that liquid nitrogen spray cryotherapy is an acceptable treatment for BE in both ablation naïve and experienced patients.

Supplementary material



Publication History

Received: 07 February 2022

Accepted after revision: 20 July 2022

Accepted Manuscript online:
21 July 2022

Article published online:
15 November 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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