Jigisha Srivastav, MD, Lillie Pitts, MD, Jason Conway, MD, MPH Wake Forest Baptist Health, Winston-Salem, NC
Introduction: Endoscopic cryoablation is a procedure that can be used for ablation of tissue in the GI tract and has primarily been utilized to help treat Barrett’s esophagus and esophageal cancers. Given the success and benefits of cryoablation, this procedure is now being used for other gastrointestinal diseases. Below we present a unique case of cryoablation being used as a palliative treatment for gastric adenomas in a patient with extensive history of familial adenomatous polyposis (FAP).
Case Description/Methods: A 77-year-old female with history of familial adenomatous polyposis requiring total proctocolectomy with end ileostomy and Whipple procedure due to high grade dysplastic duodenal and colonic polyps presented for evaluation of innumerable gastric polyps seen on surveillance EGD. The pathology of the gastric polyps revealed focal high-grade dysplasia. Unfortunately, the patient was not a candidate for endoscopic resection given the high polyp burden or gastrectomy given the high risks associated with surgery. Palliative cryoablation was offered, which the patient was amenable to. EGD was performed which showed the stomach covered with polyps. The C2 cryotherapy system was used for treatment. Six ablations were performed with 14-second exposure time per ablation. Plan to repeat EGD with cryotherapy in two months.
Discussion: The use of palliative cryotherapy for treatment of gastric adenomas has not been studied well in literature. This case demonstrates the potential of cryotherapy to help with regression of the gastric adenomas thus providing symptomatic relief for patients and prevention of progression to cancer. Cryoablation can be an option for patients who are not surgical candidates and are wanting palliative options. More research is warranted to better characterize the safety and efficacy of cryoablation for gastric adenomas.
Figure: Figure 1: A shows the endoscopic view of the stomach before cryoablation treatment and B shows endoscopic view of the stomach after cryoablation treatment.
Disclosures:
Jigisha Srivastav indicated no relevant financial relationships.
Lillie Pitts indicated no relevant financial relationships.
Jason Conway indicated no relevant financial relationships.
Jigisha Srivastav, MD, Lillie Pitts, MD, Jason Conway, MD, MPH. P2344 - Management of Gastric Adenomas by Cryoablation in the Setting of Familial Adenomatous Polyposis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
