Emerging treatments
Cryotherapy
Cryoablation is an alternative ablative technique for the treatment of dysplastic Barrett’s oesophagus mucosa. Ablation seeks to eliminate all metaplastic epithelium to prevent progression to adenocarcinoma without damaging the muscular layer of the oesophagus. Cryotherapy uses either a liquid nitrogen spray or balloon modality. Tissue destruction is achieved with a freeze and thaw cycle that leads to tissue ischaemia and degeneration. There are no long-term studies documenting effectiveness, although cryoballoon therapy may be associated with a higher stricture rate when compared with radiofrequency ablation.[59] Randomised trials results are ongoing to assess the therapy’s long-term outcomes.[60][61]
Multipolar electrocoagulation
Experimental ablative technique for mild to moderate dysplasia. Ablation seeks to eliminate all metaplasia epithelium to prevent progression to adenocarcinoma, without damaging the muscular layer of the oesophagus. No long-term studies documenting its effectiveness.[62]
Non-steroidal anti-inflammatory drugs (NSAIDs) and statins
Patients who consume NSAIDs appear to have a lower risk of developing Barrett’s oesophagus. In one case-control study, active aspirin use reduced the risk of Barrett’s oesophagus (OR 0.56 [95% confidence interval 0.39 to 0.80]).[31] This effect persisted when the analysis was limited to a subset of patients who had endoscopy performed for workup of GORD symptoms. However, no associations were found between aspirin use, smoking, or proton-pump inhibitor use.[31] There is also evidence to suggest that statin and NSAID use is synergistic. During a median follow-up period of 4.5 years, NSAID and statin use were individually associated with a reduced risk of neoplastic progression (hazard ratio [HR] 0.47 and 0.48, respectively). The protective effect increased with combined use (HR 0.22).[63]
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