Editor’s Choice- John Vargo

Associate Editor, John Vargo, MD, MPH, recommends the article “Liquid nitrogen spray cryotherapy in Barrett’s esophagus with high-grade dysplasia: long-term results” by Sonia Gosain, MD, Kim Mercer, RN, William S. Twaddell, MD, Lance Uradomo, MD, MPH, Bruce D. Greenwald, MD from the August issue.

This article gives us a clearer glimpse as to the safety and efficacy of cryotherapy in the setting of Barrett’s esophagus with high-grade dysplasia (HGD).

This is a well-documented case series with a suitably long follow-up by a center known for its expertise in cryotherapy. Initial clinical eradication was 100%. Recurrent HGD was seen in 18% of patients, with a second “cryoremission” seen in 87.5% of these cases. The rate of stricture formation was 9% with no other significant adverse events.

Figure 2Complete eradication rates for Barrett’s high-grade dysplasia and intestinal metaplasia at 2 years and at the end of the study (range 24-57 months). CE-HGD, complete eradication of high-grade dysplasia; CE-IM, complete eradication of intestinal metaplasia.

To freeze or to burn: that is the question. Clearly this study gives us tantalizing evidence that cryotherapy may be a suitable alternative to radiofrquency ablation. However, the jury is still out on the ultimate conclusion. This study should be buttressed with comparative trials pitting cryotherapy against its ablative counterpart.

Read this article on pages 260-265 of the print journal or find it online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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