Balloon cryoablation for Barrett’s oesophagus

Barrett's oesophagus happens when the normal stratified squamous epithelium in the oesophagus transforms into simple columnar epithelium. In some people, this condition may become malignant.

Current management includes lifestyle change, acid-suppressing medicines, endoscopic mucosal resection, endoscopic submucosal dissection, ablative therapies and surgery. Ablative therapies include radiofrequency ablation, photodynamic therapy, argon plasma coagulation, laser ablation, multipolar electrocoagulation and cryotherapy. See NICE's guideline on Barrett's oesophagus and stage 1 oesophageal adenocarcinoma.

This procedure is usually done using sedation. A balloon catheter is inserted through an endoscope, aligned with the dysplastic tissue in the oesophagus, and inflated. Nitrous oxide is then sprayed through a radial diffuser head within the balloon aimed at the target tissue. The tissue is destroyed by the extreme cold. The nitrous oxide gas remains fully contained within the balloon and exits through the proximal end of the catheter.

The ablation sequence is repeated until all the abnormal cells have been destroyed. Multiple ablations can be done without removing the balloon. The procedure typically takes 15 to 20 minutes to complete.