PMID- 29750984 OWN - NLM STAT- MEDLINE DCOM- 20181214 LR - 20181214 IS - 1097-6779 (Electronic) IS - 0016-5107 (Linking) VI - 88 IP - 3 DP - 2018 Sep TI - Liquid nitrogen spray cryotherapy for dysphagia palliation in patients with inoperable esophageal cancer. PG - 447-455 LID - S0016-5107(18)32673-7 [pii] LID - 10.1016/j.gie.2018.04.2362 [doi] AB - BACKGROUND AND AIMS: Dysphagia is a debilitating symptom in patients with inoperable esophageal cancer that contributes to poor quality of life and worsening nutritional status. The 2 most commonly used palliative modalities for dysphagia are radiation therapy and esophageal stent placement. However, radiation therapy is limited by adverse events (AEs) and total dose, and stent placement has a high rate of AEs, including reflux, migration, and chest pain. A relatively new modality of liquid nitrogen endoscopic spray cryotherapy has been described as salvage when other options have been exhausted and when patients are no longer receiving systemic therapy. We evaluated the safety and efficacy of cryotherapy as the primary modality for relieving dysphagia in inoperable esophageal cancer including patients receiving systemic cancer therapy. METHODS: This is a retrospective, multicenter, consecutive case series of 49 inoperable esophageal cancer patients undergoing palliative endoscopic cryotherapy at 4 specialized cancer centers from May 2014 to May 2016. The primary outcomes were change in dysphagia scores between pre- and postcryotherapy and AEs. Dysphagia was measured using a 5-point Likert scale: 0, no dysphagia; 1, dysphagia to solids; 2, dysphagia to semisolids; 3, dysphagia to liquids; 4, dysphagia to saliva. RESULTS: Thirty-nine men and 10 women with a mean age of 58 years underwent a total of 120 cryotherapy treatments. The mean dysphagia score improved significantly from 2.4 precryotherapy to 1.7 postcryotherapy (improvement of .7 points; P < .001). Minor AEs were seen in 6 of 120 (5.0%) cryotherapy treatments (1 intraprocedural and 5 postprocedural). In addition, 1 patient developed a severe intraprocedural AE of dilation-related perforation, whereas another patient developed a benign stricture requiring dilation. CONCLUSIONS: This preliminary retrospective study suggests that liquid nitrogen spray cryotherapy may be safe and effective for dysphagia palliation in inoperable esophageal cancer. Large prospective studies are needed to confirm these findings and identify patient and procedure characteristics associated with the greatest benefit. CI - Copyright (c) 2018 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved. FAU - Kachaamy, Toufic AU - Kachaamy T AD - Cancer Treatment Centers of America, Boca Raton, Florida, USA. FAU - Prakash, Ravi AU - Prakash R AD - Cancer Treatment Centers of America, Boca Raton, Florida, USA. FAU - Kundranda, Madappa AU - Kundranda M AD - Banner MD Anderson Cancer Center, Gilbert, Arizona, USA. FAU - Batish, Raman AU - Batish R AD - Cancer Treatment Centers of America, Boca Raton, Florida, USA. FAU - Weber, Jeffrey AU - Weber J AD - Cancer Treatment Centers of America, Boca Raton, Florida, USA. FAU - Hendrickson, Scott AU - Hendrickson S AD - Cancer Treatment Centers of America, Boca Raton, Florida, USA. FAU - Yoder, Leon AU - Yoder L AD - Cancer Treatment Centers of America, Boca Raton, Florida, USA. FAU - Do, Hannah AU - Do H AD - Cancer Treatment Centers of America, Boca Raton, Florida, USA. FAU - Magat, Theresa AU - Magat T AD - Cancer Treatment Centers of America, Boca Raton, Florida, USA. FAU - Nayar, Rajeev AU - Nayar R AD - Cancer Treatment Centers of America, Boca Raton, Florida, USA. FAU - Gupta, Digant AU - Gupta D AD - Cancer Treatment Centers of America, Boca Raton, Florida, USA. FAU - DaSilva, Trisha AU - DaSilva T AD - Cancer Treatment Centers of America, Boca Raton, Florida, USA. FAU - Sangal, Ashish AU - Sangal A AD - Cancer Treatment Centers of America, Boca Raton, Florida, USA. FAU - Kothari, Shivangi AU - Kothari S AD - University of Rochester Medical Center, Strong Memorial Hospital, Rochester, New York, USA. FAU - Kaul, Vivek AU - Kaul V AD - University of Rochester Medical Center, Strong Memorial Hospital, Rochester, New York, USA. FAU - Vashi, Pankaj AU - Vashi P AD - Cancer Treatment Centers of America, Boca Raton, Florida, USA. LA - eng PT - Journal Article PT - Multicenter Study DEP - 20180508 PL - United States TA - Gastrointest Endosc JT - Gastrointestinal endoscopy JID - 0010505 RN - 0 (Gases) RN - N762921K75 (Nitrogen) SB - IM MH - Adenocarcinoma/complications/*surgery MH - Adult MH - Aged MH - Aged, 80 and over MH - Carcinoma, Squamous Cell/complications/*surgery MH - *Cryosurgery MH - Deglutition Disorders/etiology/*surgery MH - Esophageal Neoplasms/complications/*surgery MH - Esophagoscopy MH - Female MH - Gases MH - Humans MH - Male MH - Middle Aged MH - Nitrogen MH - Palliative Care MH - Retrospective Studies EDAT- 2018/05/12 06:00 MHDA- 2018/12/15 06:00 CRDT- 2018/05/12 06:00 PHST- 2017/12/03 00:00 [received] PHST- 2018/04/29 00:00 [accepted] PHST- 2018/05/12 06:00 [pubmed] PHST- 2018/12/15 06:00 [medline] PHST- 2018/05/12 06:00 [entrez] AID - S0016-5107(18)32673-7 [pii] AID - 10.1016/j.gie.2018.04.2362 [doi] PST - ppublish SO - Gastrointest Endosc. 2018 Sep;88(3):447-455. doi: 10.1016/j.gie.2018.04.2362. Epub 2018 May 8.