D0214 - Safety and Efficacy of Liquid Nitrogen Spray Cryotherapy in Barrett’s Neoplasia: A Comprehensive Review and Meta-Analysis

Saurabh Chandan, MD¹, Jay Bapaye, MD², Shahab Khan, MBBS³, Smit Deliwala, MD⁴, Babu P. Mohan, MD, MS⁵, Daryl Ramai, MD, MPH⁵, Banreet S. Dhindsa, MD⁶, Hemant Goyal, MD⁷, Lena Kassab, MD⁸, Muhammad Aziz, MD⁹, Faisal Kamal, MD¹⁰, Antonio Facciorusso, MD, PhD¹¹, Douglas G. Adler, MD, FACG^12
1CHI Health Creighton School of Medicine, Omaha, NE; ²Rochester General Hospital, Rochester, NY; ³Brigham's & Children Hospital, Harvard University, Boston, MA; ⁴Michigan State University, East Lansing, MI; ⁵University of Utah School of Medicine, Salt Lake City, UT; ⁶University of Nebraska Medical Center, Omaha, NE; ⁷University of Texas McGovern Medical School, Houston, TX; ⁸Mayo Clinic, Rochester, MN; ⁹University of Toledo, Toledo, OH; ¹⁰University of California, San Francisco, San Francisco, CA; ¹¹University of Foggia, Foggia, Puglia, Italy; ¹²Centura Health-Porter Adventist Hospital, Salt Lake City, UT

Introduction: 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. We also assessed pooled rates of therapeutic failures as well as post procedure complications including strictures, pain and perforation events.

Results: Fourteen studies with 666 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), 87% (CI 82-90.8; I2 60) and 55.8% (CI 51.7-59.8; I2 73) with follow up ranging from 4.25 months to 69.7 months. Among LNSC naïve patients with prior history of endoscopic resection, the rates were 83% (CI 73.6-89.5; I2 46), 76% (CI 65.1-84.3; I2 38) and 71.8% (CI 60.9-80.7; I2 0). In patients with follow up beyond 24 months, the rates were 78.8% (CI 72.4-84.1; I2 84), 85.2% (CI 73.1-92.4; I2 1) and 54.7% (CI 47.6-61.6; I2 81). Pooled rate of therapeutic failures, defined as lack of response to LNSC therapy, was 22.1% (CI 18.3-36.6; I2 74). Post LNSC strictures and perforation pooled rates were 4% and 0.8%, respectively, which are lower than previously reported for RFA. Pooled rate of post procedure abdominal and/or chest pain was 13.6% (CI 11.3-16.3; I2 67).

Discussion: Our analysis suggests that liquid nitrogen spray cryotherapy is a durable and safe therapeutic modality for BE, in both ablation naïve and experienced patients.




Disclosures:


Saurabh Chandan, MD¹, Jay Bapaye, MD², Shahab Khan, MBBS³, Smit Deliwala, MD⁴, Babu P. Mohan, MD, MS⁵, Daryl Ramai, MD, MPH⁵, Banreet S. Dhindsa, MD⁶, Hemant Goyal, MD⁷, Lena Kassab, MD⁸, Muhammad Aziz, MD⁹, Faisal Kamal, MD¹⁰, Antonio Facciorusso, MD, PhD¹¹, Douglas G. Adler, MD, FACG¹². D0214 - Safety and Efficacy of Liquid Nitrogen Spray Cryotherapy in Barrett’s Neoplasia: A Comprehensive Review and Meta-Analysis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.