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Endoscopic spray cryotherapy for esophageal cancer: safety and efficacy.

Abstract：

BACKGROUND:Few options exist for patients with localized esophageal cancer ineligible for conventional therapies. Endoscopic spray cryotherapy with low-pressure liquid nitrogen has demonstrated efficacy in this setting in early studies. OBJECTIVE:To assess the safety and efficacy of cryotherapy in esophageal carcinoma. DESIGN:Multicenter, retrospective cohort study. SETTING:Ten academic and community medical centers between 2006 and 2009. PATIENTS:Subjects with esophageal carcinoma in whom conventional therapy failed and those who refused or were ineligible for conventional therapy. INTERVENTIONS:Cryotherapy with follow-up biopsies. Treatment was complete when tumor eradication was confirmed by biopsy or when treatment was halted because of tumor progression, patient preference, or comorbid condition. MAIN OUTCOME MEASUREMENTS:Complete eradication of luminal cancer and adverse events. RESULTS:Seventy-nine subjects (median age 76 years, 81% male, 94% with adenocarcinoma) were treated. Tumor stage included T1-60, T2-16, and T3/4-3. Mean tumor length was 4.0 cm (range 1-15 cm). Previous treatment including endoscopic resection, photodynamic therapy, esophagectomy, chemotherapy, and radiation therapy failed in 53 subjects (67%). Forty-nine completed treatment. Complete response of intraluminal disease was seen in 31 of 49 subjects (61.2%), including 18 of 24 (75%) with mucosal cancer. Mean (standard deviation) length of follow-up after treatment was 10.6 (8.4) months overall and 11.5 (2.8) months for T1 disease. No serious adverse events were reported. Benign stricture developed in 10 (13%), with esophageal narrowing from previous endoscopic resection, radiotherapy, or photodynamic therapy noted in 9 of 10 subjects. LIMITATIONS:Retrospective study design, short follow-up. CONCLUSIONS:Spray cryotherapy is safe and well tolerated for esophageal cancer. Short-term results suggest that it is effective in those who could not receive conventional treatment, especially for those with mucosal cancer.

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Greenwald BD,Dumot JA,Abrams JA,Lightdale CJ,David DS,Nishioka NS,Yachimski P,Johnston MH,Shaheen NJ,Zfass AM,Smith JO,Gill KR,Burdick JS,Mallat D,Wolfsen HC

doi

10.1016/j.gie.2010.01.042

subject

Has Abstract

pub_date

2010-04-01 00:00:00

pages

686-93

issue

4

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(10)00056-8

journal_volume

71

pub_type

杂志文章,多中心研究

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