Durability of cryoballoon ablation for eradication of neoplastic Barrett's esophagus: a multicenter prospective cohort study (with video)

BACKGROUND AND AIMS: Cryoballoon ablation (CBA) can safely and effectively eradicate neoplastic Barrett's esophagus (BE). However, there are limited data on the durability of its treatment effects. We evaluated the clinical outcomes of CBA after complete eradication of intestinal metaplasia (CE-IM) and dysplasia (CE-D). METHODS: In a prospective clinical trial, patients with BE with low-grade dysplasia, high-grade dysplasia, or intramucosal adenocarcinoma (ImCA) up to 6 cm long who underwent cryoballoon ablation after endoscopic mucosal resection (EMR) of visible lesions were enrolled at 11 academic and community centers for surveillance after CE-IM. Final diagnoses were confirmed by expert central pathology review. Study end points included rate, timing, and location of recurrences, CE-D and CE-IM at last follow-up, neoplastic progression, and adverse events. RESULTS: A total of 88 of 94 patients treated with CBA in year 1 of the trial achieved CE-IM, and 76 of these patients participated in this durability study. The median follow-up time after achieving CE-IM was 4 years (range, 1-7.9 years). Recurrence of esophageal intestinal metaplasia (IM) was noted in 9 (11.8%), with incidence of 2.9% per person-year. The incidence of recurrent BE dysplasia was 0.99% per person-year. The median time to recurrence of esophageal IM was 19 months. Neoplastic progression to esophageal ImCA occurred in 1 patient. Allowing for retreatment, CE-IM was maintained in 75 of 76 (98.6%). Four (5.3%) patients required dilation for strictures (2 pre-existing). CONCLUSIONS: In patients with neoplastic BE who achieved CE-IM, CBA eradication of all dysplasia and intestinal metaplasia was safe, highly effective, and durable for at least 3 years.