Modirian N, Wei MT, Friedland S. Cryoballoon treatment of endoscopically unresectable duodenal adenomas. World J Gastrointest Endosc 2026; 18(1): 112759 [DOI: 10.4253/wjge.v18.i1.112759]
Corresponding Author of This Article
Mike T Wei, Department of Gastroenterology and Hepatology, Stanford University Medical Center, 300 Pasteur Drive, Palo Alto, CA 94305, United States. mtwei@stanford.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Jan 16, 2026; 18(1): 112759 Published online Jan 16, 2026. doi: 10.4253/wjge.v18.i1.112759
Cryoballoon treatment of endoscopically unresectable duodenal adenomas
Negar Modirian, Mike T Wei, Shai Friedland
Negar Modirian, School of Medicine, St. George School, True Blue BB1210, Grenada
Mike T Wei, Department of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA 94305, United States
Shai Friedland, Department of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94305, United States
Shai Friedland, Gastroenterology, Stanford University, Palo Alto, CA 94305, United States
Co-corresponding authors: Mike T Wei and Shai Friedland.
Author contributions: Modirian N, Wei MT, and Friedland S contributed to planning the study; Modirian N contributed to interpreting the data, drafting and editing manuscript; Wei MT and Friedland S contributed to data collection and final revision of manuscript; Wei MT and Friedland S contributed equally to this manuscript and are co-corresponding authors.
Institutional review board statement: This retrospective study was approved by the Ethics Committee of Stanford University Administrative Panel on Human Subjects in Medical Research.
Informed consent statement: Because of retrospective study signed informed consent form is not needed. However, Stanford University has given permission to conduct this study.
Conflict-of-interest statement: Wei MT is Consultant for Neptune Medical, AgilTx, Capsovision. Friedland S is Consultant for Intuitive Surgical and Capsovision.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mike T Wei, Department of Gastroenterology and Hepatology, Stanford University Medical Center, 300 Pasteur Drive, Palo Alto, CA 94305, United States. mtwei@stanford.edu
Received: August 6, 2025 Revised: October 22, 2025 Accepted: November 17, 2025 Published online: January 16, 2026 Processing time: 162 Days and 23 Hours
Abstract
BACKGROUND
Snare polypectomy and endoscopic mucosal resection (EMR) are effective and widely utilized for treating duodenal adenomas. However, circumferential, recurrent and fibrotic adenomas can be challenging to treat with these techniques.
AIM
To develop a safe and effective treatment for these challenging lesions.
METHODS
Between 2022 and 2024, a retrospective review was performed for all patients treated with cryoballoon for duodenal adenomas at two institutions. Cryoballoon focal ablation was performed using nitrous oxide, in which a 1-second “pre-puff” of nitrous oxide was performed, followed by delivery for 10 seconds to 14 seconds. Repetition was performed as needed. Surveillance endoscopy was performed at 3 months to 12 months post-ablation to assess efficacy.
RESULTS
A total of ten individuals were treated, including six patients with recurrent adenomas following previous incomplete endoscopic resections, one patient with an extensive flat adenoma surrounding an ampullary polyp that could not be resected with a snare, and two patients with circumferential sessile duodenal adenomas longer than 5 cm that were considered unresectable by EMR. Follow-up endoscopy demonstrated no efficacy (< 20% improvement) in the two patients with circumferential sessile adenomas. Of the eight patients with non-circumferential adenomas, three had no residual adenoma. Five had significant improvement with < 40% of the adenoma remaining and were treated again with cryoballoon (3) or cold snare (2). Three of the five patients had no recurrence following the second treatment. The remainder are awaiting repeat endoscopy. Seven patients were treated as outpatients and had no adverse events. Two patients undergoing concomitant snare ampullectomy were hospitalized for observation; one developed mild pancreatitis and was discharged following a 48-hour admission, and the second patient was asymptomatic.
CONCLUSION
Cryoballoon treatment may be effective for non-circumferential flat duodenal adenomas that are not amenable to snare polypectomy or EMR, such as those with severe fibrosis from prior treatment. More than one treatment may be required. However, the treatments are safe and well-tolerated. Limited experience in two patients suggests that cryotherapy is not an effective treatment for bulky circumferential adenomas.
Core Tip: Conventional procedures for treating fibrotic, recurring, or widespread duodenal adenomas, such as snare polypectomy and endoscopic mucosal resection, may have limitations. This multicenter retrospective study examines cryoballoon ablation as a novel treatment for such complex lesions. The findings suggest that cryoballoon therapy is a safe and potentially successful treatment for non-circumferential flat adenomas, particularly those complicated by past resections and fibrosis. However, its effectiveness may be restricted in large circumferential lesions.
