PD05.05. Long-Term Outcomes of CryoBalloon Ablation for Superficial Esophageal Squamous Cell Carcinoma on Post-Endoscopic Resection Scars

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ID: 326074
2026
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Abstract
Abstract Topic Esophageal Cancer: Non-Surgical Treatment of Esophageal Cancer Background Endoscopic submucosal dissection (ESD) for superficial esophageal squamous cell carcinoma (SESCC) at post-endoscopic resection scar is technically challenging due to fibrosis. While the CryoBalloon Ablation System (CBAS) has shown favorable short-term efficacy for such lesions in a pivotal trial, its long-term outcomes remain unclear. Methods This retrospective study evaluated the long-term outcomes of patients enrolled in a prospective pivotal trial (EPOC1902) who underwent CBAS for cT1a SESCC arising on or adjacent to post-endoscopic resection scars at two tertiary referral centers in Japan. Eligible lesions were clinically confined to the mucosa, with no evidence of lymph node or distant metastasis, and were deemed unsuitable for ESD because of severe fibrosis. Cryoablation was delivered for 8 or 10 seconds per freezing application, and the number of applications individualized to cover the entire lesion. The primary endpoint was the 3-year local complete response (L-CR) rate of the main lesion. Secondary endpoints included L-CR rate of all treated lesions, recurrence-free survival (RFS), overall survival (OS), and adverse events. L-CR was defined as endoscopic absence of residual tumor with complete epithelialization of the post-treatment ulcer. Local recurrence was defined as histologically confirmed squamous cell carcinoma at a previous L-CR site. Results Fifteen patients with 17 lesions were included (median age 74; 14 male). Background esophageal mucosa showed Lugol-voiding lesion graded as B in 7 patients and C in 8. The median follow-up was 4.2 years. Among 12 patients with 13 lesions available for 3-year assessment, the 3-year L-CR was 91.7% for main lesions and 92.3% for all treated lesions. Only one local recurrence occurred, presenting as superficial carcinoma and successfully managed with ESD. The 3-year RFS and OS were 86.7% and 93.3%, respectively, with no esophageal cancer-related deaths. Esophageal stricture developed in three patients. However, two of these occurred after subsequent ESD for metachronous lesions adjacent to the treated site, and only one case of stricture was observed following the CBAS treatment. Conclusion Cryoablation using CBAS demonstrated favorable long-term local control for SESCC arising on or adjacent to post-endoscopic resection scars where ESD is technically difficuly. The high 3-year L-CR rate and acceptable safety profile suggest that CBAS is a viable, minimally invasive treatment option for this challenging clinical setting.
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Authors Yuji Owaki, Hironori Sunakawa, Satoru Nonaka, Seiichiro Abe, Takashi Ikeno, Masashi Wakabayashi, Hiroki Yamashita, Tomohiro Kadota, Tomonori Yano
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Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.108
URL
https://doi.org/10.1093/dote/doag077.108
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