First Report of Spray Cryosurgery Depth of Injury to the Human Esophagus

Introduction: This study provides histologic documentation of spray cryosurgery (SCS) affect on human tissue at varying dose. SCS is a non-contact method of destroying unwanted tissue using low-pressure liquid nitrogen. The rapid freezing and thawing associated with SCS evokes significant cellular damage through a variety of pathways leaving the stroma essentially unaffected, avoiding the potential for mechanical injury attendant to other thermal modalities. While SCS is well documented in the gastrointestinal tract, this is the first report evaluating depth of injury in the human esophagus.

Methods and Procedures: SCS was administered to unaffected esophageal tissue during a standard esophagogastroduodenoscopy seven days prior to a cancer related esophagectomy. Study design includes a comparison of two doses; four cycles of 10 seconds in the first patient and two cycles of 20 seconds in the second patient. Patients were monitored as per institutional guidelines. Herein we report the initial results from each. After specimens were obtained, pathologic inspection was performed along the entirety of the injury.

Results: Histological findings are noted in Table 1. There was no evidence of scarring or stricturing. The stroma was not affected by SCS. Side effects included dysphagia and moderate chest pain, both of which resolved spontaneously and required no medications. Adjacent organs were not affected and SCS did not affect the patient’s surgical outcome.

Conclusions: Initial results from this study demonstrate transmural esophageal injury without evidence of perforation or stricture formation. These results suggest a unique wound response to SCS-induced injury compared to other thermal modalities and warrant further examination to characterize the cellular basis of this response. Based on this limited sample size, 20 seconds x 2 sprays induces a more consistent, deeper injury pattern than 10 seconds x 4 sprays. These findings also support the eradication of advanced disease in other reported uses of SCS.

Table 1.

Dose= 10 seconds x 4 sprays

Specimen orientation Depth of inflammation Depth of hemorrhage Depth of necrosis
1.0cm proximal to center muscularis propria none submucosa
0.5cm proximal to center muscularis propria none mucosa
center of spray submucosa none mucosa
0.5cm distal to center mucosa (deep) none mucosa
1.0cm distal to center submucosa none mucosa

Dose= 20 seconds x 2 sprays

Specimen orientation Depth of inflammation Depth of hemorrhage Depth of necrosis
1.0cm proximal to center muscularis propria none submucosa (superficial)
0.5cm proximal to center muscularis propria submucosa submucosa (deep)
center of spray muscularis propria submucosa submucosa (deep)
0.5cm distal to center muscularis propria submucosa (superficial) submucosa (deep)
1.0cm distal to center submucosa (superficial) none submucosa (superficial)

Session: Poster

Program Number: P367

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