A physician at Jersey City Medical Center is one of the first in the New York metropolitan area to use a procedure known as spray cryotherapy to treat patients with dysplasia, or pre-cancerous cell changes, in their esophagus. This is a condition that can develop in patients with Barrett's esophagus, a disorder caused by acid reflux (or GERD).
During the procedure, which takes 30 – 40 minutes while the patient is under sedation, the physician sprays extremely cold (minus 196 degrees Celsius) liquid nitrogen on the tissue in the esophagus to flash freeze and destroy it, allowing healthy tissue to replace it.
"This offers a vast improvement to previous treatments," said Dr. Harry Snady, a board certified gastroenterologist at Jersey City Medical Center. "Like an artist, the doctor 'paints' the areas where there is abnormal tissue. Following therapy, the frozen tissue dies and sloughs off, allowing new healthy tissue to regenerate in its place."
Irene Fuellbier, a 68-year-old Queens woman, who had the procedure performed two weeks ago by Dr. Snady, called it "one of the easiest procedures to go through. I never felt more than a mild irritation and it was over before I knew it."
Fuellbier suffers from severe heartburn which, over a number of years, had developed into Barrett's esophagus, a disorder that affects an estimated 3.3 million Americans. Those with Barrett's have a higher risk of developing esophageal cancer, a particularly deadly form of cancer.
Previous treatments for esophageal dysplasia or pre-dysplasia include surgery or radiofrequency ablation (RFA), where heat energy is applied to the diseased lining of the esophagus. Both of these procedures can cause significant discomfort as well as swallowing problems and other complications.
With cryotherapy, the freezing agent is delivered endoscopically to the affected tissue through a catheter, with the physician using a fiberoptic viewing system. In some cases, several treatments, scheduled six to eight weeks apart, may be required.
"It's really an astounding procedure," said Dr. Snady, who holds both MD and PhD degrees, and was involved in the original clinical trials several years ago. "It's an extremely effective procedure and there are almost never any side effects."
Some people with Barrett's esophagus may experience a chronic cough, similar to asthma. Many, however, experience no specific symptoms, but may report episodes of heartburn more frequently than several times a week.
For patients with high-grade dysplasia, Dr. Snady generally recommends endoscopic ultrasound to get a baseline exam of the lymph nodes in the area around the Barrett's and to ensure that there is no invasive cancer already present. People with heart instability or certain rare genetic diseases may not qualify for the new procedure. Patients whose dysplasia has already progressed to esophageal cancer can be treated with cryotherapy, he said, as long as the cancer is still superficial.
Cryotherapy is a proven therapy that has been used for decades to treat diseased tissue on the skin and in many other parts of the body, including breast, liver, cervical, prostate and lungs.
The incidence of esophageal cancer has risen about six-fold in the U.S. over the last 30 years – a rate faster than that of breast, prostate or skin cancers. Early diagnosis and intervention are considered key.
Jersey City Medical Center is the first New Jersey hospital to offer the procedure, and one of only three in the entire metropolitan area. It is covered by most insurances.