P1.004. Cryoablation of Barrett´s Esophagus in Patients not Suitable for Treatment With Radiofrequency Ablation

Abstract

Abstract Topic Benign Disease: Barrett’s Esophagus: Pathology and Pathophysiology; Non-invasive Neoplasia Background Radiofrequency ablation (RFA) is the gold standard for ablation of the esophagus. However, there are occasions when RFA is not suitable, for example if the patient has suffered side effects from RFA, responded poorly to the ablation, or if it for various reasons is difficult to use existing RFA catheters. Cryoablation is a ablation method in which liquid nitrogen is sprayed into a balloon-catheter. The balloon freezes the mucosa instead of burning it. We wanted to evaluate the cryoablation cases where RFA previously has not worked well or where RFA has not been deemed to be useful. Methods At Karolinska University Hospital, we have conducted a retrospective review of all patients who have undergone cryoablation for Barrett´s esophagus since 2023. Results In our department nine patients, four women and five men, with Barrett´s esophagus, have undergone cryoablation. The average age was 74 years (50 to 82 years). Five patients were so-called "poor responders" and had responded poorly to RFA, two had complications after RFA and two patients had an esophagus that was too narrow to be accessible with RFA catheters of the appropriate size. Two patients are in complete remission after cryoablation, five patients have responded to cryoablation but are still under treatment, and one patient does not appear to have responded to cryoablation at all. One patient who had experienced severe pain after RFA also experienced severe pain after cryoablation. All cryoablations were performed without complications. Conclusion Cryoablation may be considered when RFA, for various reasons, is not considered an appropriate treatment method. However, it seems that most patients who have not responded well to RFA also do not respond well to cryoablation.