Background and Aims

EMR is the preferred endoscopic therapy for duodenal adenomas (DAs) but is associated with an overall adverse event rate of 26%. Cryotherapy using a Cryoballoon Focal Ablation System (CbFAS) can safely and effectively eradicate esophageal intestinal metaplasia. We report our first experience with cryoballoon ablation for treatment of flat DAs.

Methods

This was an American, multicenter, retrospective study involving 5 centers. DAs (Paris 0-IIa and 0-IIb) were treated with nitrous oxide for 5 to 12 seconds using CbFAS. Follow-up EGD was performed at 3 to 12 months.

Results

Seventeen DAs (mean size, 22.7 ± 14.3 mm; 12 tubular, 5 tubulovillous) from 13 patients (mean age, 66.5 ± 9.99 years; 61.5% males) were included in the study. Thirteen of 17 DAs (76.5%) had failed previous treatment, and 4 of 17 (23.5%) were treatment naÏve. All procedures were technically successful and achieved a >50% decrease in size after cryoballoon ablation There was no increase in size or progression of disease for any lesions. Overall, treatment was completed in 15 of 17 patients, and recurrence-free survival was achieved in 12 of 17 (71%) after a median follow-up of 15.5 months (interquartile range [IQR], 6.8-19.4). The median cryoablation time per polyp was 4 minutes (IQR, 1-7.5 minutes), and the median total procedure time was 25 minutes (IQR, 22-30.5 minutes). There were no intra- or postprocedural adverse events.

Conclusions

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

中文翻译：

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使用一氧化二氮冷冻气球治疗扁平十二指肠腺瘤的初步多中心经验（视频）。

背景和目标

EMR是十二指肠腺瘤（DAs）的首选内窥镜治疗方法，但总不良事件发生率为26％。使用冷冻气球聚焦消融系统（CbFAS）进行冷冻疗法可以安全有效地根除食道肠上皮化生。我们报告了冷冻气球消融治疗扁平DA的首次经验。

方法

这是一项涉及5个中心的美国多中心回顾性研究。使用CbFAS将一氧化二氮处理DAs（巴黎0-IIa和0-IIb）5到12秒。在3至12个月时进行随访EGD。

结果

研究包括来自13位患者（平均年龄，66.5±9.99岁；男性61.5％）的17个DA（平均大小，22.7±14.3 mm； 12个管状，5个微管）。17例DA中有13例（76.5％）先前治疗失败，而17例中有4例（23.5％）尚未接受治疗。所有手术在技术上都是成功的，并且在冷冻气球消融后尺寸减小了50％以上。对于任何病变，尺寸均没有增加或疾病进展。总体而言，在中位随访时间为15.5个月（四分位间距[IQR]，6.8-19.4）之后，17名患者中的15名完成了治疗，17名患者中的12名（71％）实现了无复发生存。每个息肉的中位冷冻消融时间中位数为4分钟（IQR，1-7.5分钟），中位总手术时间为25分钟（IQR，22-30.5分钟）。没有术中或术后不良事件。

结论

非息肉状DA的一氧化二氮冷冻球囊切除术是可行的，具有安全性和有效性。