Expanding the therapeutic spectrum for duodenal adenomas: Cryoballoon ablation

Abstract

Duodenal adenomas are clinically significant premalignant lesions; however, their management is frequently challenging due to fibrosis, recurrence, and the procedural risks associated with resection-based techniques such as endoscopic mucosal resection and endoscopic submucosal dissection. Cryoballoon ablation (CBA) has recently emerged as a non-resection alternative that delivers controlled nitrous oxide-based cryotherapy while reducing the likelihood of deep mural injury. A recent two-center retrospective series by Modirian et al published in World Journal of Gastrointestinal Endoscopy involving ten patients demonstrated the high technical success and meaningful clinical efficacy of CBA for non-circumferential flat adenomas including lesions with severe fibrosis that precluded effective snare capture. Most patients achieved substantial lesion regression or complete eradication with an excellent safety profile, requiring only occasional repeat sessions. In contrast, bulky circumferential sessile lesions showed minimal or no response, underscoring an important limitation of this modality. Current evidence indicates that CBA represents a valuable therapeutic option for carefully selected complex duodenal adenomas; however, prospective studies are needed to clarify the long-term durability, recurrence rates, and optimal candidates for this approach.

Keywords: Cryoballoon ablation; Duodenum; Adenoma; Dysplasia; Endoscopy; Gastrointestinal

Core Tip: Cryoballoon ablation provides a selective, depth-limited injury that preserves the collagen matrix, making it a promising option for duodenal adenomas when conventional resection is unsafe. This technique is particularly useful for flat, fibrotic, or recurrent lesions for which endoscopic mucosal resection is difficult or hazardous and in which thermal ablation carries an increased perforation risk. This modality may fill an important therapeutic niche for patients with anatomically challenging or high-risk adenomas.