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Letter to the Editor Cryotherapy versus radiofrequency ablation in the treatment of post-chemoradiotherapy patients with recurrence of Barrett’s dysplasia
Shiraz Mohammed Khan1orcid, Sirsha Kundu1orcid, Jade Godfrey2orcid, Claudio Buggiotti2orcid, Hasan Haboubi2,3,orcid
Clinical Endoscopy 2025;58(1):161-162.
DOI: https://doi.org/10.5946/ce.2024.221
Published online: December 12, 2024

1School of Medicine, Cardiff University, Cardiff, United Kingdom

2Department of Gastroenterology, Cardiff & Vale University Health Board, Llandough, United Kingdom

3Cancer Biomarker Group, Institute of Life Sciences, Swansea University, Swansea, United Kingdom

Correspondence: Hasan Haboubi Department of Gastroenterology, University Hospital Llandough, Penlan Road, Llandough, Penarth, CF64 2XX, United Kingdom E-mail: hasan.n.haboubi@wales.nhs.uk
• Received: August 16, 2024   • Revised: August 29, 2024   • Accepted: August 30, 2024

© 2025 Korean Society of Gastrointestinal Endoscopy

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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We read with great interest the recent article by Gomes et al.,1 which demonstrates no differences between radiofrequency ablation (RFA) and cryotherapy in achieving complete eradication of intestinal metaplasia, complete eradication of dysplasia (CE-D), or recurrence rates in treatment-naïve Barratt’s dysplasia patients.
However, patients referred for endoscopic eradication may be more heterogeneous in a wider population than those in the cohort of this study. We found that patients who are not surgical candidates and have had previous definitive chemoradiotherapy with curative intent for esophageal adenocarcinoma treatment but subsequently experience Barrett’s dysplasia recurrence can prove challenging to manage.
Between May 2020 and June 2023, the South Barrett’s RFA center received 85 new patient referrals for dysplastic Barrett’s disease, of which 8 had underwent chemoradiotherapy for esophageal cancer (Table 1).
We noted that patients who had previously received chemoradiotherapy had a significantly lower CE-D rate (12.5%) than treatment-naïve patients (80.5%, p<0.001) when RFA was used to eradicate Barrett’s dysplasia following initial endoscopic resection for visible lesions.
The reasons for this are unclear but are likely to reflect a biologically more unstable disease in which the recurrence of dysplasia following systemic chemotherapy is unlikely to respond to superficial ablative techniques. Endoscopic resection was also proven to be more challenging in our dataset, which was likely attributable to the significant submucosal fibrosis from radiotherapy.
Lal et al.2 reported that cryotherapy ablates at a deeper level of the esophageal tissue and has a lower stricture rate than RFA. Furthermore, a recent article by Aintabi et al.3 highlighted the effectiveness of cryotherapy in the palliation of squamous cell esophageal cancer and posed interesting questions about whether this effectiveness is because of its ability to control deeper mucosal and submucosal diseases.
Based on this literature and our abovementioned findings, we propose that in patients who received chemoradiotherapy for non-surgically viable esophageal adenocarcinoma and experienced a recurrence of dysplastic Barrett’s disease, alternative therapy to RFA such as cryotherapy should be considered, and further research in this area is necessary.
Table 1.
Comparison of patients with treatment-naïve dysplastic or neoplastic Barrett’s and those who had previously received definitive chemoradiotherapy
Treatment-naïve patients (n=77) Previous chemoradiotherapy-treated patients (n=8) p-value
Age (yr) 67.9±10.1 77.3±5.9 0.26
Circumferential Barrett’s at first procedure (cm) 3.09±3.7 3.00±2.9 0.83
Maximal extent of Barrett’s at first procedure (cm) 4.65±3.6 4.71±2.6 0.71
Histopathology 0.89
 LGD 19 (24.7) 2 (25.0)
 HGD 42 (54.5) 4 (50.0)
 Adenocarcinoma 13 (16.9)a) 2 (25.0)
CE-D rate at 1-year 62 (80.5) 1 (12.5) < 0.001
Complication rates
 Strictures 5 (6.5) 4 (50.0) < 0.001

Values are presented as mean±standard deviation or number (%).

LGD, low-grade dysplasia; HGD, high-grade dysplasia; CE-D, complete eradication of dysplasia.

a)T1a, 8/T1b, 5.

  • 1. Gomes IL, de Moura DT, Ribeiro IB, et al. Cryotherapy versus radiofrequency ablation in the treatment of dysplastic Barrett's esophagus with or without early esophageal neoplasia: a systematic review and meta-analysis. Clin Endosc 2024;57:181–190.ArticlePubMedPMCPDF
  • 2. Lal P, Thota PN. Cryotherapy in the management of premalignant and malignant conditions of the esophagus. World J Gastroenterol 2018;24:4862–4869.ArticlePubMedPMC
  • 3. Aintabi D, Saliares A, Berinstein E, et al. Effective palliative treatment of obstructive metastatic esophageal squamous cell carcinoma for nearly 2 years with liquid nitrogen cryoablation alone. ACG Case Rep J 2024;11:e01259.ArticlePubMedPMC

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        Cryotherapy versus radiofrequency ablation in the treatment of post-chemoradiotherapy patients with recurrence of Barrett’s dysplasia
        Clin Endosc. 2025;58(1):161-162.   Published online December 12, 2024
        DOI: https://doi.org/10.5946/ce.2024.221
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      Related articles
      Cryotherapy versus radiofrequency ablation in the treatment of post-chemoradiotherapy patients with recurrence of Barrett’s dysplasia
      Cryotherapy versus radiofrequency ablation in the treatment of post-chemoradiotherapy patients with recurrence of Barrett’s dysplasia
      Treatment-naïve patients (n=77) Previous chemoradiotherapy-treated patients (n=8) p-value
      Age (yr) 67.9±10.1 77.3±5.9 0.26
      Circumferential Barrett’s at first procedure (cm) 3.09±3.7 3.00±2.9 0.83
      Maximal extent of Barrett’s at first procedure (cm) 4.65±3.6 4.71±2.6 0.71
      Histopathology 0.89
       LGD 19 (24.7) 2 (25.0)
       HGD 42 (54.5) 4 (50.0)
       Adenocarcinoma 13 (16.9)a) 2 (25.0)
      CE-D rate at 1-year 62 (80.5) 1 (12.5) < 0.001
      Complication rates
       Strictures 5 (6.5) 4 (50.0) < 0.001
      Table 1. Comparison of patients with treatment-naïve dysplastic or neoplastic Barrett’s and those who had previously received definitive chemoradiotherapy

      Values are presented as mean±standard deviation or number (%).

      LGD, low-grade dysplasia; HGD, high-grade dysplasia; CE-D, complete eradication of dysplasia.

      a)T1a, 8/T1b, 5.

      Table 1.

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