Cryotherapy

Cryoablation involves cooling a region of the body, in this case the esophagus, to a level at which permanent cell death occurs, resulting in eliminated of unwanted tissue. Cryoablation has been used to treat pre-cancerous changes, known as dysplasia, as well as early cancers with a goal of total eradication of all abnormal cells. For more advanced tumors, it can be used in a palliative capacity to reduce tumor burden to improve the ability to swallow. The degree and depth of ablation achieved is based on the number of times the area is frozen and also by how long the area is held frozen for. At higher doses, cryoablation can achieve a greater depth of ablation than radiofrequency ablation. For this reason, it can be used to treat nodular disease that cannot be resected endoscopically for technical or safety reasons.

Cryoablation can be done via a variety of techniques. These include the use of a liquid nitrogen spray, a carbon dioxide spray, and a nitrous oxide balloon. These procedures typically take 30-45 minutes of procedure time and are done in an outpatient setting. In addition to ablation of cancerous or pre-cancerous tissue, these methods can be used to treat benign conditions, such as difficult to manage esophageal strictures. The technique is well tolerated and rarely associated with pain. Post treatment strictures can occur, but typically at a rate comparable to that seen with other esophageal ablation modalities. Treatments can typically be performed at 4-8 week intervals.