Comparison of Tissue Architectural Changes between Radiofrequency Ablation and Cryospray Ablation in Barrett’s Esophagus Using Endoscopic Three-Dimensional Optical Coherence Tomography
Two main nonsurgical endoscopic approaches for ablating dysplastic and early cancer lesions in the esophagus have gained popularity, namely, radiofrequency ablation (RFA) and cryospray ablation (CSA). We report a uniquely suited endoscopic and near-microscopic imaging modality, three-dimensional (3D) optical coherence tomography (OCT), to assess and compare the esophagus immediately after RFA and CSA. The maximum depths of architectural changes were measured and compared between the two treatment groups. RFA was observed to induce 230~260？ m depth of architectural changes after each set of ablations over a particular region, while CSA was observed to induce edema-like spongiform changes to ~640？ m depth within the ablated field. The ability to obtain micron-scale depth-resolved images of tissue structural changes following different ablation therapies makes 3D-OCT an ideal tool to assess treatment efficacy. Such information could be potentially used to provide real-time feedback for treatment dosing and to identify regions that need further retreatment. 1. Introduction Radiofrequency ablation (RFA) and cryospray ablation (CSA) are recently developed methods that utilize thermal gradients to treat dysplastic and early cancer lesions of the esophagus, such as those arising in the setting of Barrett’s esophagus (BE). Both therapeutic technologies allow broad and superficial treatment fields for BE [1–8]. Recent clinical trials using RFA treatment have shown that complete eradication of dysplasia (CE-D) was achieved in 98% and 93% of patients with low-grade dysplasia (LGD) and high-grade dysplasia (HGD) at two-year followup [9]. Complete eradication of intestinal metaplasia (CE-IM) was achieved in 92% of patients with nondysplastic BE (NDBE) at up to 5 years of followup [10]. CSA is a newer therapeutic technology, so fewer large-scale clinical trials have been conducted. However, several pilot studies have shown that CSA is highly effective in eradicating HGD [6–8]. Complete eradication of the HGD, CE-D, and CE-IM in 94%, 88%, and 53% of BE patients was reported in a multicenter study [8]. Another multicenter study also reported 97%, 87%, and 57% complete eradication of HGD, CE-D, and CE-IM at 10.5 months of followup [7]. Although these studies indicate that both therapeutic technologies allow broad and superficial treatment fields for BE, repeated RFA/CSA treatments were generally required to achieve complete treatment response. On average, CE-IM was achieved after over 3.4 sessions using RFA [4, 9, 10] and 4.2 sessions using CSA [8, 11] for patients with
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