Background and Aims

Strong evidence supports the use of radiofrequency ablation (RFA) in the management of dysplastic/neoplastic Barrett’s esophagus (BE). Recently, the efficacy of the cryoballoon ablation (CBA) system was demonstrated in multicenter cohort studies. We aimed to assess the comparative effectiveness and safety of these 2 ablation modalities for endoscopic eradication therapy (EET) in a cohort study.

Methods

Data were abstracted on patients with dysplastic BE or intramucosal carcinoma undergoing EET using RFA or CBA as the primary ablation modality at 2 referral centers. The primary outcome was the rate of complete remission intestinal metaplasia (CRIM). Secondary outcomes were rates of complete remission of dysplasia (CRD) and adverse events. Cox proportional hazards models and propensity scored–matched analyses were conducted to compare outcomes.

Results

Three hundred eleven patients (CBA, 85 patients; RFA, 226 patients) with a median follow-up of 1.5 years (interquartile range, .8, 2.5) in the RFA group and 2.0 years (interquartile range, 1.3, 2.5) in the CBA group were studied. On multivariable analyses, the chances of reaching CRD and CRIM were not influenced by ablation modality. Propensity score–matched analysis revealed a comparable chance of achieving CRIM (CBA vs RFA: hazard ratio, 1.24; 95% confidence interval, .79-1.96; P = .35) and CRD (CBA vs RFA: hazard ratio, 1.19; 95% confidence interval, .82-1.73; P = .36). The CBA group had a higher stricture rate compared with the RFA group (10.4% vs 4.4%, P = .04).

Conclusions

Histologic outcomes of EET using CBA and RFA for dysplastic BE appear to be comparable. A randomized trial is needed to definitively compare outcomes between these 2 modalities.

中文翻译：

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射频消融和冷冻球囊消融在发育不良的巴雷特食管中的比较结果：倾向评分匹配的队列研究

背景和目标

强有力的证据支持使用射频消融术 (RFA) 治疗发育不良/肿瘤性巴雷特食管 (BE)。最近，冷冻球囊消融 (CBA) 系统的功效在多中心队列研究中得到证实。我们的目的是在一项队列研究中评估这两种消融方式用于内镜根除治疗 (EET) 的比较有效性和安全性。

方法

在 2 个转诊中心使用 RFA 或 CBA 作为主要消融方式，对接受 EET 的发育不良 BE 或粘膜内癌患者的数据进行了抽象。主要结果是完全缓解肠化生（CRIM）的发生率。次要结果是发育不良完全缓解 (CRD) 和不良事件的发生率。进行 Cox 比例风险模型和倾向评分匹配分析以比较结果。

结果

311 名患者（CBA，85 名患者；RFA，226 名患者），RFA 组中位随访时间为 1.5 年（四分位距，0.8, 2.5），RFA 组中位随访时间为 2.0 年（四分位距，1.3, 2.5） CBA组进行了研究。在多变量分析中，达到 CRD 和 CRIM 的机会不受消融方式的影响。倾向得分匹配分析显示实现 CRIM（CBA 与 RFA：风险比，1.24；95% 置信区间，0.79-1.96；P  = .35）和 CRD（CBA 与 RFA：风险比，1.19；95）的机会相当% 置信区间，0.82-1.73；P  = .36）。与 RFA 组相比，CBA 组的狭窄率更高（10.4% vs 4.4%，P  = .04）。

结论

使用 CBA 和 RFA 治疗发育不良 BE 的 EET 的组织学结果似乎具有可比性。需要一项随机试验来明确比较这两种方式之间的结果。