| Endoscopic cryotherapy: experimental results and first clinical use. | |
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MedLine Citation:
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PMID: 10228263 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Cryotherapy or the application of extreme cold has many potential applications in gastroenterology including tissue destruction and hemostasis but until now its development has been prevented by the lack of a delivery device suitable for use through the endoscope. We report here our experience with prototype devices using both liquid nitrogen driven by a cryosurgical system and cryogenic refrigerants (nitrous oxide and carbon dioxide) at or near ambient temperature. METHODS: Cryotherapy was applied to the distal esophageal mucosa of dogs via a flexible catheter passed through an upper endoscope. In other dogs, cryotherapy was used for hemostasis in a bleeding ulcer model. The procedure was also used for palliation in a 58-year-old man with unresectable adenocarcinoma of the stomach with pyloric channel obstruction. RESULTS: Freezing of the superficial mucosa was nearly instantaneous. All dogs survived the procedure and appeared to thrive. Histologic evaluation revealed significant necrosis of the superficial epithelial layer accompanied by a fibrinocellular infiltrate on the surface. These markers of acute injury subside by the fourth to sixth day and are replaced by regenerating epithelium, a process that is virtually complete by day 10. In the hemostasis experiments, bleeding ceased immediately after cryospraying of the lesions but resumed on thawing in most cases. Application of cryotherapy in the patient resulted in reduction of the pyloric mass with no immediately apparent adverse effects. CONCLUSIONS: These data, although preliminary, demonstrate the feasibility of endoscopic cryotherapy using a simple hand-held device. This device has broad potential for use in gastroenterology including ablation of superficial epithelium, debulking of large tumors and hemostasis. |
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Authors:
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P J Pasricha; S Hill; K S Wadwa; G T Gislason; P I Okolo; C A Magee; M I Canto; W H Kuo; J G Baust; A N Kalloo |
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Publication Detail:
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Type: Case Reports; Journal Article; Review |
Journal Detail:
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Title: Gastrointestinal endoscopy Volume: 49 ISSN: 0016-5107 ISO Abbreviation: Gastrointest. Endosc. Publication Date: 1999 May |
Date Detail:
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Created Date: 1999-06-16 Completed Date: 1999-06-16 Revised Date: 2005-11-16 |
Medline Journal Info:
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Nlm Unique ID: 0010505 Medline TA: Gastrointest Endosc Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 627-31 Citation Subset: IM |
Affiliation:
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Division of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, Texas 77555-0764, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adenocarcinoma
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therapy Animals Cryotherapy / instrumentation, methods* Disease Models, Animal Dogs Endoscopes, Gastrointestinal Endoscopy, Gastrointestinal / methods* Equipment Design Esophagus / pathology Fatal Outcome Humans Male Middle Aged Mucous Membrane / pathology Peptic Ulcer Hemorrhage / therapy Pylorus Stomach Neoplasms / therapy Stomach Ulcer / complications, therapy |
| Comments/Corrections | |
Comment In:
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Gastrointest Endosc. 2001 Jun;53(7):840
[PMID:
11375611
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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