Cryotherapy involves flash freezing of tissue and removing unwanted tissue. Mechanism of injury is causing cell membrane rupture by rapid multiple freeze–thaw cycles, while reserving tissue architecture and the collagen matrix. This promotes favorable wound healing. In recent years, it has gained increasing attention as a treatment option for upper gastrointestinal diseases (Barrett’s Esophagus and early cancer). Currently, two FDA-approved delivery methods are available in the GI tract: Cryoballoon and spray cryotherapy, which will be discussed. In this review, we also propose to examine the expanding role of cryotherapy in gastrointestinal practice, drawing from both clinical studies and illustrative vignettes. In addition, we will highlight its established role in eradicating Barrett’s with low and high-grade dysplasia and compare its outcomes and safety profile with radiofrequency ablation (RFA). We will also discuss the application and safety of spray cryotherapy in the palliation of malignant esophageal strictures when compared with Esophageal stent placement. Cryotherapy may have immunological potential, and it may shrink both primary and metastatic diseases. Ongoing research in this field of Cryo-immunology will be highlighted. Beyond esophageal neoplasia, cryotherapy is increasingly utilized in other upper gastrointestinal precancerous conditions. Through this synthesis, our goal is to provide a timely and comprehensive overview of advancements in cryotherapy and its potential to reshape novel therapeutic approaches in upper gastrointestinal cancers. Finally, we highlight the evolution of a novel platform using nitrous oxide delivered by a handheld device, a contact balloon, and a small replaceable cartridge. This approach may make delivery of cryogen application favorable and a first-line approach in the management of Barrett’s esophagus and early cancer. In addition, Cryoballoon therapy for dysphagia palliation for malignant esophageal strictures may become a preferred approach as more data evolves.
冷冻疗法涉及对组织进行快速冷冻并移除不需要的组织。其损伤机制是通过多次快速冻融循环导致细胞膜破裂，同时保留组织结构与胶原基质，从而促进良好的伤口愈合。近年来，该疗法作为上消化道疾病（巴雷特食管和早期癌症）的治疗选择受到越来越多的关注。目前，胃肠道领域有两种经美国食品药品监督管理局批准的递送方法：冷冻球囊疗法和喷雾冷冻疗法，本文将对此进行讨论。本综述还旨在结合临床研究和典型案例，探讨冷冻疗法在胃肠道实践中的扩展应用。此外，我们将重点阐述其在消除低级别和高级别异型增生的巴雷特食管中的既定作用，并将其疗效和安全性特征与射频消融进行比较。同时，我们将讨论喷雾冷冻疗法与食管支架置入相比，在缓解恶性食管狭窄方面的应用和安全性。冷冻疗法可能具有免疫学潜力，并可能缩小原发性和转移性病灶。本文将重点介绍冷冻免疫学领域的持续研究。除食管肿瘤外，冷冻疗法在其他上消化道癌前病变中的应用也日益增多。通过综合论述，我们的目标是及时全面地概述冷冻疗法的进展及其重塑上消化道癌症新型治疗方法的潜力。最后，我们重点介绍了一种新型平台的发展，该平台使用一氧化二氮，通过手持设备、接触球囊和小型可替换储罐进行递送。这种方法可能使冷冻剂的应用更为便利，并成为巴雷特食管和早期癌症治疗的一线方案。此外，随着更多数据的积累，冷冻球囊疗法缓解恶性食管狭窄所致的吞咽困难可能成为优选方案。
Freeze the Disease: Advances the Therapy for Barrett’s Esophagus and Esophageal Adenocarcinoma
肿瘤(癌症)患者之家