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    Balloon cryoablation for treating Barrett's oesophagus

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    1 Recommendations

    1.1

    More research is needed on balloon cryoablation to treat Barrett's oesophagus in adults before it can be used in the NHS.

    1.2

    This procedure should only be done as part of formal research and a research ethics committee needs to have approved its use.

    What this means in practice

    There is not enough evidence to know if this procedure is safe or effective. Balloon cryoablation to treat Barrett's oesophagus in adults should only be done as part of formal research.

    Auditing of outcomes

    Data on safety and outcomes should be collected for everyone having the procedure and entered into the C2 CryoBalloon Ablation International Research Database Registry..

    Who should be involved with the procedure

    Patient selection and the procedure should be done by an appropriately constituted multidisciplinary team of gastroenterologists, pathologists and surgeons with specific training in this procedure.

    What research is needed

    More research, in the form of longer-term prospective studies, is needed on:

    • patient selection (including people with different Barrett's oesophagus segment -lengths, people without previous RFA treatment, and people whose Barrett's oesophagus is resistant to RFA who are having balloon cryoablation as a secondary treatment)

    • longer-term efficacy outcomes, such as time to recurrence and freedom from dysplasia and internal metaplasia, especially compared with standard care (radiofrequency ablation), for the cryoablation duration used in NHS practice

    • safety outcomes (in particular, stricture formation), for the cryoablation duration used in NHS practice.

    Why the committee made these recommendations

    There is little good-quality evidence on the safety and efficacy of this procedure. All the evidence comes from observational studies. The results suggest that, in some people, balloon cryoablation may cause less pain and be better tolerated or more appropriate than radiofrequency ablation. In the short term, it also appears to be as effective as radiofrequency ablation in terms of cancer prevention and recurrence. But it has not been directly compared with radiofrequency ablation in a randomised controlled trial. Also, long-term data is lacking. So, more research is needed on long-term clinical effectiveness and safety, and for different populations.