Jigisha Srivastav, MD1, Jason Conway, MD, MPH2 1Wake Forest Baptist Health, Winston-Salem, NC; 2Atrium Health Wake Forest Baptist, Winston-Salem, NC
Introduction: Endoscopic cryotherapy is an emerging therapeutic modality that can be used to treat many different gastrointestinal diseases including Barrett’s esophagus and esophageal cancers. Standard treatment for patients with esophageal squamous cell carcinoma includes endoscopic/surgical resection and chemoradiation however endoscopic cryotherapy has been shown to help with symptom management and treatment of early esophageal cancers. Below we present a case where endoscopic cryotherapy successfully cured esophageal squamous cell carcinoma.
Case Description/Methods: A 54-year-old male with medical history significant for HIV, treated hepatitis C, polysubstance abuse, GERD, and atrial fibrillation presented to the outpatient gastroenterology clinic with worsening dysphagia. He subsequently underwent EGD which showed grade B esophagitis and an ulcerated lesion at the GE junction which was subsequently biopsied. The biopsy revealed high grade squamous dysplasia with features of at least intramucosal squamous cell carcinoma. He was referred to surgical oncology and they determined that he was not a candidate for esophagectomy given his poor health status, underlying debility, and extremely poor exercise intolerance. He underwent EUS which showed a small, ulcerated lesion in the lower third of esophagus with evidence suggesting invasion to deep mucosa, and two enlarged lymph nodes concerning for likely early stage but probably not amenable to EMR. His only standard treatment option left was chemoradiation however he was offered endoscopic cryotherapy as an alternative which he was agreeable for. The C2 cryotherapy system was used, and the patient underwent a total of seven sessions with the last session showing completely normal mucosa. Patient has another EGD planned in four months for continued surveillance.
Discussion: There is very limited data on the use of endoscopic cryoablation for esophageal squamous cell carcinoma when compared to esophageal adenocarcinoma. However, the presented case demonstrates the viability of endoscopic cryotherapy as a less invasive alternative. Further comprehensive studies are warranted to ascertain the potential integration of endoscopic cryotherapy into the standardized treatment protocols for esophageal squamous cell carcinoma.
Figure: Figure A and B: Images from the first EGD during cryotherapy application
Disclosures:
Jigisha Srivastav indicated no relevant financial relationships.
Jason Conway indicated no relevant financial relationships.
Jigisha Srivastav, MD1, Jason Conway, MD, MPH2. P2797 - Endoscopic Cryotherapy as an Alternative Option to Chemoradiation for Successful Treatment of Esophageal Squamous Cell Carcinoma, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
