Cryoballoon treatment of endoscopically unresectable duodenal adenomas

Table 1 Baseline characteristics of patients undergoing cryoballoon ablation for duodenal adenomas

Case	Age	Sex	Comorbidities	Location	Prior treatment	Size at first cryogenic (mm)	Morphology	Fibrosis	Pathology	Cryogenic performed	Adverse event	Follow-up outcome
1	73	Male	Cardiomyopathy, metastatic cancer	D3	Tattoo and biopsy	20 mm	Flat	Severe	Adenomas	12 seconds × 2 sites	None	Minimal residual adenoma at 4 months (5 mm, biopsied and repeat cryoballoon), no further surveillance due to severe comorbidities
2	55	Male		D2	Incomplete EMR	15 mm	Flat	Severe	Adenomas	10 seconds × 2 sites	None	Two 8 mm residual adenomas were ablated at 3 months, 3 mm residual adenomas at 8 months were ablated, and no residual adenomas were found at biopsy at 15 months
3	77	Male	FAP	D1, D3 (including periampullary)	Biopsy	100 mm	Circumferential sessile	None	Adenomas	12 seconds × 9 sites	None	< 20% improvement at 4 months, cryogenic repeated (12 seconds × 6 sites), no improvement at 9 months. Adenoma on biopsy
4	72	Male		D2	Incomplete EMR and Ovesco for bleeding	20 mm	Flat and Ovesco are attached	Severe	Adenomas	12 seconds × 3 sites	None	Ovesco was still attached at 6 months, removed by traction. 1/3 of adenoma remained, removed by cold snare. Awaiting repeat endoscopy
5	71	Male		D2, D3 (starting 1 cm distal to ampulla)	Biopsy	50 mm	Circumferential sessile	None	Adenomas	12 seconds × 12 sites	None	< 20% improvement at 2 months. Repeat biopsy of adenoma. Had surgical resection (adenoma)
6	70	Female	Cirrhosis with varices	D1	EMR/band	10 mm	Flat	Severe	HGD	10 seconds × 1 sites	None	No recurrence at 1 year (biopsy normal)
7	78	Female	Prior XRT for lymphoma	D2	PEMR with clip	15 mm	Flat with clip attached	Severe	HGD	10 seconds × 1 sites	None	2/3 gone at 3 months, repeat ablation 10 seconds × 3 sites, no recurrence on biopsy at 6 months or 18 months
8	78	Female		D2 (including ampulla)	None	50 mm	Flat, unable to grasp the snare	Mild	HGD	10 seconds × 5 sites	None	90% gone at 6 months, treated with cold snare. Recurrence at the ampulla treated with snare at 12 months. No recurrence on 18-month follow-up
9	41	Female	FAP	D1, D2 (including near the ampulla)	PEMR	20 mm	Flat	Severe	Adenomas	10 seconds × 4 sites	Admitted 48 hours for mild pancreatitis	No recurrence at 6 months
10	52	Male		D2	PEMR/tattoo	20 mm	Flat (IIa + IIc)	Severe	Foveolar metaplasia but only small piece so unclear	14 seconds × 3 sites	None	No recurrence at 6 months

FAP: Familial adenomatous polyposis; XRT: Radiation therapy; D3: Horizontal duodenum; D2: Distal duodenum; D1: Duodenal bulb; EMR: Endoscopic mucosal resection; PEMR: Piecemeal endoscopic mucosal resection; HGD: High-grade dysplasia.