Post written by Charlotte N. Frederiks, MD, from the Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, the Netherlands, and the Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Focal cryoballoon ablation is investigated for the treatment of Barrett’s esophagus–related neoplasia in a European multicenter study known as the Euro-Coldplay study.
After inclusion of 28 of the planned 107 patients, this study was temporarily paused because of an unexpected high stricture rate compared with previous literature. With the aim of improving safety while preserving efficacy, the initial dose of 10 seconds was reduced to 8 seconds, and 28 patients were subsequently treated with the lower dose.
For the current study, we compared the efficacy and safety of a single focal cryoballoon ablation treatment with 10-second doses versus 8-second doses in the 56 patients who were consecutively enrolled in the Euro-Coldplay study.
This comparative study formed the basis for the formal decision whether continuation of the Euro-Coldplay study was justified after the dose reduction. In addition, this study aimed to evaluate whether 8 seconds could be recommended as the standard dose to ensure safety of focal cryoballoon ablation while maintaining efficacy.
This is the first study comparing 2 doses for focal cryoballoon ablation to show that a lower dose of 8 seconds is equally effective as 10 seconds. Overall, the stricture rate did not significantly differ between both doses, although severe strictures requiring more than 3 dilations were solely seen in the 10-second group. Considering that a dose of 8 seconds may theoretically result in fewer and less severe strictures, we suggest using 8 seconds as a standard dose for focal cryoballoon ablation.
Ultimately, the results from the ongoing Euro-Coldplay study, during which patients undergo a maximum of 5 repetitive focal cryoballoon treatments, will provide us with more definite data on the efficacy and safety of focal cryoballoon ablation in patients with Barrett’s esophagus.
Focal cryoballoon ablation treatment. A and B, Flat-type C0M5 Barrett’s esophagus (BE) with high-grade dysplasia. C, The first application of focal cryoballoon ablation with 8-second dose created an ice patch. D, The entire BE segment was treated with 12 ablations of 8 seconds after which a distinctive red mucosal color was visible. E and F, Follow-up endoscopy at 12 weeks showed C0M0 BE (E) with some remaining Barrett islands at the 4, 6, and 8 o’clock position (F), resulting in a median BE surface regression score of 85% without esophageal scarring.
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