Endoscopic eradication therapy with multifocal cryoballoon ablation for Barrett esophagus-related neoplasia

Charlotte Frederiks; Anouk Overwater; Torsten Beyna; Horst Neuhaus; Raf Bisschops; Roos E Pouw; Jacques Jghm Bergman; Maximilien Barret; Roberta Maselli; Vinay Sehgal; Rehan Haidry; Bas L A M Weusten

doi:10.1055/a-2710-6551

Endoscopic eradication therapy with multifocal cryoballoon ablation for Barrett esophagus-related neoplasia

Charlotte Frederiks
, Anouk Overwater
, Torsten Beyna
, Horst Neuhaus
, Raf Bisschops
, Roos E Pouw
, Jacques Jghm Bergman
, Maximilien Barret
, Roberta Maselli
, Vinay Sehgal
, Rehan Haidry
, Bas L A M Weusten

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background

Focal cryoballoon ablation (FCBA) is a relatively new ablation modality for the treatment of Barrett esophagus (BE)-related neoplasia. This prospective, multicenter study aimed to evaluate the efficacy and safety of FCBA for the treatment of BE.

Methods

In eight European Barrett expert centers, patients with a C≤2M≤5 BE segment (according to Prague classification) with dysplasia or early cancer were eligible for inclusion. Before entry, any visible lesion if present had to be removed by endoscopic resection (ER). FCBA was performed by trained endoscopists at 3-month intervals until complete eradication of BE (max. 5 sessions). After at least two FCBA sessions, add-on treatment was allowed. Post-treatment, follow-up endoscopy was scheduled at 6 months and annually thereafter. Outcomes were complete eradication of endoscopically visible BE (CE-BE), intestinal metaplasia (CE-IM), and dysplasia (CE-D), durability of treatment response and adverse events.

Results

107 patients (91 males; mean age 65) with a median BE of C0M2 were included. ER at entry was performed in 65% (69/107) followed by a median of 2 FCBA treatments. Add-on treatment was performed in 40% (43/107), mainly APC for small remaining islands (38%; 41/107). CE-BE and CE-D was achieved in 94% (101/107; 95% CI 90%-98%) and CE-IM in 91% (97/107; 95% CI 85%-95%), per intention-to-treat analysis. Per-protocol analysis, CE-BE and CE-D was achieved in 100% (101/101; 95% CI 100%-100%), and CE-IM in 96% (97/101; 95% CI 92%-99%). After a median follow-up of 18 months, 96% (97/101; 95% CI 92%-99%) remained free of endoscopically visible BE. Esophageal stricture was the most common adverse event in 13% (13/101; 95% CI 6%-20%).

Conclusion

In expert hands, endoscopic eradication therapy with FCBA is highly effective in selected patients with BE of limited length, although the potential risk for stricture formation warrants further research.

Original language	English
Pages (from-to)	323-333
Journal	Endoscopy
Volume	58
Early online date	26 Sept 2025
DOIs	https://doi.org/10.1055/a-2710-6551
Publication status	Published - Apr 2026

Access to Document

10.1055/a-2710-6551Licence: CC BY

a-2710-6551Final published version, 1.49 MBLicence: CC BY

Cite this

@article{58ff5f746c16436696a1288d9e7ff24d,

title = "Endoscopic eradication therapy with multifocal cryoballoon ablation for Barrett esophagus-related neoplasia",

abstract = "Background Focal cryoballoon ablation (FCBA) is a relatively new ablation modality for the treatment of Barrett esophagus (BE)-related neoplasia. This prospective, multicenter study aimed to evaluate the efficacy and safety of FCBA for the treatment of BE. Methods In eight European Barrett expert centers, patients with a C≤2M≤5 BE segment (according to Prague classification) with dysplasia or early cancer were eligible for inclusion. Before entry, any visible lesion if present had to be removed by endoscopic resection (ER). FCBA was performed by trained endoscopists at 3-month intervals until complete eradication of BE (max. 5 sessions). After at least two FCBA sessions, add-on treatment was allowed. Post-treatment, follow-up endoscopy was scheduled at 6 months and annually thereafter. Outcomes were complete eradication of endoscopically visible BE (CE-BE), intestinal metaplasia (CE-IM), and dysplasia (CE-D), durability of treatment response and adverse events. Results107 patients (91 males; mean age 65) with a median BE of C0M2 were included. ER at entry was performed in 65\% (69/107) followed by a median of 2 FCBA treatments. Add-on treatment was performed in 40\% (43/107), mainly APC for small remaining islands (38\%; 41/107). CE-BE and CE-D was achieved in 94\% (101/107; 95\% CI 90\%-98\%) and CE-IM in 91\% (97/107; 95\% CI 85\%-95\%), per intention-to-treat analysis. Per-protocol analysis, CE-BE and CE-D was achieved in 100\% (101/101; 95\% CI 100\%-100\%), and CE-IM in 96\% (97/101; 95\% CI 92\%-99\%). After a median follow-up of 18 months, 96\% (97/101; 95\% CI 92\%-99\%) remained free of endoscopically visible BE. Esophageal stricture was the most common adverse event in 13\% (13/101; 95\% CI 6\%-20\%). Conclusion In expert hands, endoscopic eradication therapy with FCBA is highly effective in selected patients with BE of limited length, although the potential risk for stricture formation warrants further research.",

author = "Charlotte Frederiks and Anouk Overwater and Torsten Beyna and Horst Neuhaus and Raf Bisschops and Pouw, \{Roos E\} and Bergman, \{Jacques Jghm\} and Maximilien Barret and Roberta Maselli and Vinay Sehgal and Rehan Haidry and Weusten, \{Bas L A M\}",

note = "The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).",

year = "2026",

month = apr,

doi = "10.1055/a-2710-6551",

language = "English",

volume = "58",

pages = "323--333",

journal = "Endoscopy",

issn = "0013-726X",

publisher = "Georg Thieme Verlag",

}

TY - JOUR

T1 - Endoscopic eradication therapy with multifocal cryoballoon ablation for Barrett esophagus-related neoplasia

AU - Frederiks, Charlotte

AU - Overwater, Anouk

AU - Beyna, Torsten

AU - Neuhaus, Horst

AU - Bisschops, Raf

AU - Pouw, Roos E

AU - Bergman, Jacques Jghm

AU - Barret, Maximilien

AU - Maselli, Roberta

AU - Sehgal, Vinay

AU - Haidry, Rehan

AU - Weusten, Bas L A M

N1 - The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

PY - 2026/4

Y1 - 2026/4

N2 - Background Focal cryoballoon ablation (FCBA) is a relatively new ablation modality for the treatment of Barrett esophagus (BE)-related neoplasia. This prospective, multicenter study aimed to evaluate the efficacy and safety of FCBA for the treatment of BE. Methods In eight European Barrett expert centers, patients with a C≤2M≤5 BE segment (according to Prague classification) with dysplasia or early cancer were eligible for inclusion. Before entry, any visible lesion if present had to be removed by endoscopic resection (ER). FCBA was performed by trained endoscopists at 3-month intervals until complete eradication of BE (max. 5 sessions). After at least two FCBA sessions, add-on treatment was allowed. Post-treatment, follow-up endoscopy was scheduled at 6 months and annually thereafter. Outcomes were complete eradication of endoscopically visible BE (CE-BE), intestinal metaplasia (CE-IM), and dysplasia (CE-D), durability of treatment response and adverse events. Results107 patients (91 males; mean age 65) with a median BE of C0M2 were included. ER at entry was performed in 65% (69/107) followed by a median of 2 FCBA treatments. Add-on treatment was performed in 40% (43/107), mainly APC for small remaining islands (38%; 41/107). CE-BE and CE-D was achieved in 94% (101/107; 95% CI 90%-98%) and CE-IM in 91% (97/107; 95% CI 85%-95%), per intention-to-treat analysis. Per-protocol analysis, CE-BE and CE-D was achieved in 100% (101/101; 95% CI 100%-100%), and CE-IM in 96% (97/101; 95% CI 92%-99%). After a median follow-up of 18 months, 96% (97/101; 95% CI 92%-99%) remained free of endoscopically visible BE. Esophageal stricture was the most common adverse event in 13% (13/101; 95% CI 6%-20%). Conclusion In expert hands, endoscopic eradication therapy with FCBA is highly effective in selected patients with BE of limited length, although the potential risk for stricture formation warrants further research.

AB - Background Focal cryoballoon ablation (FCBA) is a relatively new ablation modality for the treatment of Barrett esophagus (BE)-related neoplasia. This prospective, multicenter study aimed to evaluate the efficacy and safety of FCBA for the treatment of BE. Methods In eight European Barrett expert centers, patients with a C≤2M≤5 BE segment (according to Prague classification) with dysplasia or early cancer were eligible for inclusion. Before entry, any visible lesion if present had to be removed by endoscopic resection (ER). FCBA was performed by trained endoscopists at 3-month intervals until complete eradication of BE (max. 5 sessions). After at least two FCBA sessions, add-on treatment was allowed. Post-treatment, follow-up endoscopy was scheduled at 6 months and annually thereafter. Outcomes were complete eradication of endoscopically visible BE (CE-BE), intestinal metaplasia (CE-IM), and dysplasia (CE-D), durability of treatment response and adverse events. Results107 patients (91 males; mean age 65) with a median BE of C0M2 were included. ER at entry was performed in 65% (69/107) followed by a median of 2 FCBA treatments. Add-on treatment was performed in 40% (43/107), mainly APC for small remaining islands (38%; 41/107). CE-BE and CE-D was achieved in 94% (101/107; 95% CI 90%-98%) and CE-IM in 91% (97/107; 95% CI 85%-95%), per intention-to-treat analysis. Per-protocol analysis, CE-BE and CE-D was achieved in 100% (101/101; 95% CI 100%-100%), and CE-IM in 96% (97/101; 95% CI 92%-99%). After a median follow-up of 18 months, 96% (97/101; 95% CI 92%-99%) remained free of endoscopically visible BE. Esophageal stricture was the most common adverse event in 13% (13/101; 95% CI 6%-20%). Conclusion In expert hands, endoscopic eradication therapy with FCBA is highly effective in selected patients with BE of limited length, although the potential risk for stricture formation warrants further research.

U2 - 10.1055/a-2710-6551

DO - 10.1055/a-2710-6551

M3 - Article

C2 - 41005363

SN - 0013-726X

VL - 58

SP - 323

EP - 333

JO - Endoscopy

JF - Endoscopy

ER -

Endoscopic eradication therapy with multifocal cryoballoon ablation for Barrett esophagus-related neoplasia

Abstract

Access to Document

Fingerprint

Cite this