P0888 - Utilization of Cryotherapy for the Management of Premalignant Lesions in Patients on Anticoagulation

Praneeth Kudaravalli, MD¹, Aneesha Gummadi, MS¹, Michael Temple, MD¹, Dariush Shahsavari, MD², Kwabena Adu-Gyamfi, MD³, Kenneth J. Vega, MD, FACG³, John Erikson Yap, MD, MBA^3
1Augusta University, Augusta, GA; ²Medical College of Georgia, Augusta, GA; ³Medical College of Georgia at Augusta University, Augusta, GA

Introduction: Radiofrequency ablation (RFA) is a common technique used for the treatment of benign, pre-malignant and malignant lesions. However, one possible severe complication is bleeding, and it is currently recommended to hold anticoagulation prior to pursuing RFA. Cryotherapy has been demonstrated to be an alternative to RFA and is reported to have lower risk of bleeding. Cryotherapy causes tissue destruction by repetition of rapid cooling and slow thawing. It involves the use of liquid nitrogen to cause cell membrane destruction and protein denaturation leading to direct cell death. We report two cases who remained on anticoagulation during cryotherapy with no post-procedural bleeding.

Case Description/Methods: Case 1: An 80-year-old male with history of long segment Barrett’s Esophagus (BE) with low grade dysplasia (C12M12), atrial fibrillation and mitral valve annuloplasty with prosthetic mitral valve on warfarin presented for management of BE. Through shared decision making regarding RFA vs cryotherapy ablation, cryotherapy ablation was decided to be pursued. Patient’s medications including warfarin were continued. He underwent treatment with Cryotherapy – 20 second cycles X 2 cycles for 6 segments. The mucosa appeared erythematous after the treatment as expected. No significant post procedure bleeding was noted. He underwent 3 more procedures with no issues.

Case 2: A 79-year-old male with history of atrial fibrillation on apixaban presented to GI clinic for a 30mm gastric adenoma with dysplasia. EMR was attempted but the borders were not clear as the spot ink diffusely spread through the area. After a multidisciplinary discussion, cryotherapy ablation was suggested as an option and the patient decided to go ahead as it was non-invasive. The patient continued his anticoagulation. The patient underwent treatment with cryotherapy – 20 seconds x 2 cycles for 4 segments with expected erythema. No significant post procedure bleeding was noted. He underwent 4 more procedures with no issues.

Discussion: While RFA is often the preferred initial treatment of several premalignant lesions, the risk of bleeding with the procedure precludes patients who are taking anticoagulation from safely undergoing the procedure. Unlike RFA, there are fewer specific guidelines regarding halting anticoagulation prior to cryotherapy. Our cases demonstrate that it is safe to continue anticoagulation during cryotherapy. Further standardized evaluation is needed to delineate the bleeding risk of cryoablation.




Disclosures:


Praneeth Kudaravalli, MD¹, Aneesha Gummadi, MS¹, Michael Temple, MD¹, Dariush Shahsavari, MD², Kwabena Adu-Gyamfi, MD³, Kenneth J. Vega, MD, FACG³, John Erikson Yap, MD, MBA³. P0888 - Utilization of Cryotherapy for the Management of Premalignant Lesions in Patients on Anticoagulation, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.