Cryoablation of Barrett's esophagus: a pilot study.

BACKGROUND: Numerous ablative modalities have demonstrated varying degrees of efficacy in the eradication of Barrett's esophagus (BE). However, they are associated with either high cost, patient discomfort, complications, tedious application, residual underlying BE, or some combination of the above. The aim of this study was to evaluate the safety and the efficacy of a new cryogenic device by using liquid nitrogen sprayed through an open tipped cryogenic catheter placed through the accessory channel of an upper endoscope. METHODS: A prospective, single center study was performed on patients with a long-standing history of BE followed in a Barrett's registry. Patients with degrees of dysplasia ranging from none to multifocal high-grade dysplasia were treated. All patients were treated with 40 mg rabeprazole 3 times per day during the treatment period. Elimination of acid reflux was confirmed via 24-hour esophageal pH studies. Cryoablation was applied hemicircumferentially to 4-cm-long segments at monthly intervals, until the entire segment of BE was eliminated. RESULTS: Eleven patients were treated. There was reversal of BE in all patients. In 9 of 11 (78%) patients who completed the protocol, there was complete endoscopic and histologic reversal of BE. There was no subsquamous specialized intestinal metaplasia at the 6-month follow-up. No complications occurred. CONCLUSIONS: Based on preliminary results, low-pressure spray cryoablation of BE under direct endoscopic visualization is safe and easy to perform. Its relative lack of patient discomfort and its simplicity and demonstrated efficacy make it a modality that should be further explored in the ablation of GI mucosal lesions such as BE and perhaps early esophageal cancer.

Colonoscopic screening of average-risk women for colorectal neoplasia.

BACKGROUND: Veterans Affairs (VA) Cooperative Study 380 showed that some advanced colorectal neoplasias (i.e., adenomas at least 1 cm in diameter, villous adenomas, adenomas with high-grade dysplasia, or cancer) in men would be missed with the use of flexible sigmoidoscopy but detected by colonoscopy. In a tandem study, we examined the yield of screening colonoscopy in women. METHODS: To determine the prevalence and location of advanced neoplasia, we offered colonoscopy to consecutive asymptomatic women referred for colon-cancer screening. The diagnostic yield of flexible sigmoidoscopy was calculated by estimating the proportion of patients with advanced neoplasia whose lesions would have been identified if they had undergone flexible sigmoidoscopy alone. Lesions were considered detectable by flexible sigmoidoscopy if they were in the distal colon or if they were in the proximal colon in patients who had concurrent small adenomas in the distal colon, a finding that would have led to colonoscopy. The results were compared with the results from VA Cooperative Study 380 for age-matched men and women with negative fecal occult-blood tests and no family history of colon cancer. RESULTS: Colonoscopy was complete in 1463 women, 230 of whom (15.7 percent) had a family history of colon cancer. Colonoscopy revealed advanced neoplasia in 72 women (4.9 percent). If flexible sigmoidoscopy alone had been performed, advanced neoplasia would have been detected in 1.7 percent of these women (25 of 1463) and missed in 3.2 percent (47 of 1463). Only 35.2 percent of women with advanced neoplasia would have had their lesions identified if they had undergone flexible sigmoidoscopy alone, as compared with 66.3 percent of matched men from VA Cooperative Study 380 (P<0.001). CONCLUSIONS: Colonoscopy may be the preferred method of screening for colorectal cancer in women.