Nitrous oxide cryoballoon ablation effective treatment of duodenal adenomas

EMR is the preferred endoscopic therapy for duodenal adenomas (DAs) but is associated with an overall adverse event rate of 26%. For most nonampullary duodenal adenomas, EMR is effective, but it carries a somewhat alarming rate of adverse events, particularly for larger lesions >2 cm. These include immediate bleeding (43%), delayed bleeding (15%-26%), and perforation (4%). The rich vascular supply, thin wall, fixed nature, and angulation of the duodenum all contribute to these risks. Cryotherapy using a Cryoballoon Focal Ablation System (CbFAS) can safely and effectively eradicate esophageal intestinal metaplasia. However, its effect on duodenal adenomas remains unclear. For this purpose, researchers conducted a study to investigate the safety and efficacy of nitrous oxide cryoballoon for the treatment of flat duodenal adenomas and reported their evidence.

It was an American population-based, multicenter, retrospective study in 13 patients with 17 DAs, 4 of which were treatment-naive, who underwent treatment with CbFAS and then were followed for 15.5 months at 5 study centers. Researchers treated DAs (Paris 0-IIa and 0-IIb) with nitrous oxide for 5 to 12 seconds using CbFAS.

Key findings of the study were:

♦All procedures were successfully performed and the researchers observed more than 50% decrease in size of the lesion after cryoballoon ablation with no increase in size or progression of the disease for any lesions.

♦They noted that the median cryoablation time per polyp was 4 minutes, and the median total procedure time was 25 minutes.

♦They reported that treatment was completed in 15 of 17 patients, and after a median follow-up of 15.5 months, they found that recurrence-free survival rate was achieved in 71% of patient.

♦They observed no adverse event during intra- and postprocedural period.

The authors concluded, "Nitrous oxide cryoballoon ablation of nonpolypoid DAs is feasible, with promising safety and efficacy".

For further information:

https://www.giejournal.org/article/S0016-5107(20)34398-4/fulltext#%20