Medical researchers at the National Naval Medical Center, Bethesda,
MD, have come up with a promising potential treatment for Barrett's esophagus
(BE).
In a pilot study published in the December issue of Gastrointestinal Endoscopy (GIE), an endoscopic spray cryotherapy was used to treat 11 male BE patients, and 9 (78%) of the patients who completed the protocol had complete reversal of BE, with no complications.
Called cryoablation, the new treatment uses liquid nitrogen (-196: C) sprayed at low pressure (2-4 psi) through an open-tipped cryogenic catheter placed through an accessory channel of an upper endoscope. The BE tissue is destroyed by freezing it for 20 seconds, allowing it to thaw, then re-freezing it again for 20 seconds.
The treatment is done on a small segment of the tissue (about 4.0 cm long) at monthly intervals, in conjunction with drug therapy to control acid reflux, until the entire condition is eradicated. The mean number of cryo treatments was 3.6 (range: 1-6).
Surveillance endoscopy was done monthly following the cryotherapy period to check for residual ulceration. Once endoscopic evidence showed that the BE was gone, the esophagus was sprayed with Lugol's iodine followed by systematic biopsies of the entire treated segment of BE. Once compete cryoablation was achieved, the patients had a six-month check-up and were released from the program, but will continue regular surveillance endoscopies for any change in the esophagus.
The report stated that the cryoablation pilot study's preliminary results indicated that the treatment is safe, easy to perform, and produces a relative lack of patient discomfort. "These pilot results make this a modality that should be further explored in the ablation of gastrointestinal mucosal lesions such as Barrett's esophagus and perhaps early esophageal cancer," according to the report author.
Barrett's esophagus is a condition in which the esophagus lining changes, becoming similar to the tissue that lines the intestines. This process is called intestinal metaplasia.
While the risk of getting cancer of the esophagus is less than one percent per year, the risk of developing cancer of the esophagus is 30 to 125 times higher in people who have Barrett's esophagus than in people who do not.
According to the ASGE, 10-12% of those with chronic reflux disease will develop BE. It is about twice as common in men as in women, and much more common in Caucasian males than in men of other races.
Various types of ablation modalities have been explored for destroying the BE tissue, including lasers, multi-polar electro coagulators, endoscopic mucosal resection (EMR), argon plasma coagulation (APC), radio frequency ablation and photodynamic therapy (PDT). PDT is the only modality currently approved by the Food & Drug Administration (FDA) for treatment of BE.
Complications from these other ablative modalities are not uncommon, such as chest pain, esophageal stricture, or fever.
There were no significant complications during any of the cryoablation treatments or following the 46 treatments in the study. "More data are required," the report stated. "Ablation therapy, and in particular cryoablation, is experimental and should be reserved for further exploration in the context of a research protocol."
The following authors were actively involved in protocol development, execution of the protocol and editing of the manuscript: Drs. Mark H. Johnston, John A. Eastone, and J. Dave Horwhat and Jennifer Cartledge, B.S. The following authors were actively involved in execution of the protocol and editing the final manuscript: Jacinda F. Foggy, and Janice S. Mathews, CGRN.
The American Society for Gastrointestinal Endoscopy (ASGE), founded in 1941, is the preeminent professional organization dedicated to advancing the practice of Endoscopy. ASGE, with more than 8,500 physician members worldwide, promotes the highest standards for endoscopic training and practice, fosters endoscopic research, recognizes distinguished contributions to Endoscopy, and is the foremost resource for endoscopic education.
About ASGE:
http://www.asge.org 630-573-0600
Patient Information:
http://www.askasge.org 866-305-ASGE
Contact:
Barbara Connell
630/570-5616
bconnell@asge.org
SOURCE:
American Society for Gastrointestinal Endoscopy
Web Site:
http://www.asge.org
http://www.askasge.org
In a pilot study published in the December issue of Gastrointestinal Endoscopy (GIE), an endoscopic spray cryotherapy was used to treat 11 male BE patients, and 9 (78%) of the patients who completed the protocol had complete reversal of BE, with no complications.
Called cryoablation, the new treatment uses liquid nitrogen (-196: C) sprayed at low pressure (2-4 psi) through an open-tipped cryogenic catheter placed through an accessory channel of an upper endoscope. The BE tissue is destroyed by freezing it for 20 seconds, allowing it to thaw, then re-freezing it again for 20 seconds.
The treatment is done on a small segment of the tissue (about 4.0 cm long) at monthly intervals, in conjunction with drug therapy to control acid reflux, until the entire condition is eradicated. The mean number of cryo treatments was 3.6 (range: 1-6).
Surveillance endoscopy was done monthly following the cryotherapy period to check for residual ulceration. Once endoscopic evidence showed that the BE was gone, the esophagus was sprayed with Lugol's iodine followed by systematic biopsies of the entire treated segment of BE. Once compete cryoablation was achieved, the patients had a six-month check-up and were released from the program, but will continue regular surveillance endoscopies for any change in the esophagus.
The report stated that the cryoablation pilot study's preliminary results indicated that the treatment is safe, easy to perform, and produces a relative lack of patient discomfort. "These pilot results make this a modality that should be further explored in the ablation of gastrointestinal mucosal lesions such as Barrett's esophagus and perhaps early esophageal cancer," according to the report author.
Barrett's esophagus is a condition in which the esophagus lining changes, becoming similar to the tissue that lines the intestines. This process is called intestinal metaplasia.
While the risk of getting cancer of the esophagus is less than one percent per year, the risk of developing cancer of the esophagus is 30 to 125 times higher in people who have Barrett's esophagus than in people who do not.
According to the ASGE, 10-12% of those with chronic reflux disease will develop BE. It is about twice as common in men as in women, and much more common in Caucasian males than in men of other races.
Various types of ablation modalities have been explored for destroying the BE tissue, including lasers, multi-polar electro coagulators, endoscopic mucosal resection (EMR), argon plasma coagulation (APC), radio frequency ablation and photodynamic therapy (PDT). PDT is the only modality currently approved by the Food & Drug Administration (FDA) for treatment of BE.
Complications from these other ablative modalities are not uncommon, such as chest pain, esophageal stricture, or fever.
There were no significant complications during any of the cryoablation treatments or following the 46 treatments in the study. "More data are required," the report stated. "Ablation therapy, and in particular cryoablation, is experimental and should be reserved for further exploration in the context of a research protocol."
The following authors were actively involved in protocol development, execution of the protocol and editing of the manuscript: Drs. Mark H. Johnston, John A. Eastone, and J. Dave Horwhat and Jennifer Cartledge, B.S. The following authors were actively involved in execution of the protocol and editing the final manuscript: Jacinda F. Foggy, and Janice S. Mathews, CGRN.
The American Society for Gastrointestinal Endoscopy (ASGE), founded in 1941, is the preeminent professional organization dedicated to advancing the practice of Endoscopy. ASGE, with more than 8,500 physician members worldwide, promotes the highest standards for endoscopic training and practice, fosters endoscopic research, recognizes distinguished contributions to Endoscopy, and is the foremost resource for endoscopic education.
About ASGE:
http://www.asge.org 630-573-0600
Patient Information:
http://www.askasge.org 866-305-ASGE
Contact:
Barbara Connell
630/570-5616
bconnell@asge.org
SOURCE:
American Society for Gastrointestinal Endoscopy
Web Site:
http://www.asge.org
http://www.askasge.org
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