August 22, 2023
EDMONTON — Albertans now have access to a minimally invasive, non-surgical treatment option at hospitals in both Calgary and Edmonton that helps prevent esophageal cancer.
Gastroenterology programs in the two cities have recently added the option of endoscopic cryotherapy – a targeted freezing technique delivered inside the esophagus.
In January, Paulette Barry became the first Albertan to receive cryotherapy for endoscopic ablation when Dr. Clarence Wong, gastroenterologist, Royal Alexandra Hospital, used targeted liquid nitrogen to freeze pre-cancerous cells in the tissue of her esophagus. The 65-year-old Edmontonian has suffered from severe acid reflux for decades, requiring two stomach surgeries and routine scopes to both monitor and treat the impact of chronic gastroesophageal reflux disease.
“I’ve struggled with acid reflux for so many years and had so many different types of procedures and surgeries,” says Barry. “I’ve had two cryotherapy treatments and the heartburn is gone and the biopsies are coming back looking good. I feel great.”
Barry developed Barrett’s esophagus due to long-term exposure to stomach acid, causing inflammation and damage to the cells that line the inside of her esophagus. Barrett's is a condition where the lining of the tube that carries food from your mouth to your stomach (esophagus) becomes damaged.
Barrett’s increases the risk of esophageal cancer, a major concern to Barry and her physicians as the disease claimed her father’s life.
“For advanced cases of Barrett’s, the current provincial protocol is to start with endoscopic radiofrequency ablation which uses heat to remove the damaged cells the esophagus, a treatment that was unsuccessful for Paulette,” says Dr. Wong.
“Now, with access to endoscopic cryotherapy we have another minimally invasive option that patients can receive as a day procedure. This will help prevent the progression to cancer and help patients avoid more complex and painful surgeries.”
Last year, physicians from the Royal Alex in Edmonton and South Health Campus in Calgary travelled to John Hopkins in Baltimore, Maryland to learn how to perform the procedure. During the procedure, a thin, flexible tube with a special tool at the end (an endoscope) is inserted through the mouth using cold energy (cryotherapy) to reach the affected area where nitrous oxide is delivered at -85° C to freeze the tissue. Within days, the dead tissue sloughs off and the esophagus heals. Patients undergo a follow-up examination three months later, at which time retreatment is performed for any residual areas of Barrett’s esophagus.
Dr. Milli Gupta, gastroenterologist, South Health Campus, notes that “cryotherapy has dramatically improved our approach to treating patients with Barrett's. Previously we would have to stop and keep following patients who did not respond to currently available endoscopic treatments or recommend surgery. With cryotherapy, we can continue to offer minimally invasive treatment options that are well-tolerated and safe.”
She adds that “having access to cryotherapy is a step forward in care for our patients. In the six months we have had access to cryotherapy, we have seen Barrett’s eliminated from the esophagus. We have now started to explore its use in squamous cell cancer and other precancerous lesions of the esophagus.”
Since January, 24 patients have received one or more endoscopic cryotherapy treatment across Alberta. All recent patients were discharged home within 24 hours of surgery and none required hospital readmission. In general, patients require little or no medication for post-op pain control, and recover more quickly compared to patients who undergo traditional cancer operations.
Barry is happy to know the new technique is available to other patients suffering from chronic heart burn and at risk of developing cancer.
“Some people may think heart burn is just a minor inconvenience, but it can lead to serious health issues. Esophageal cancer took my dad’s life,” says Barry. “I am so grateful this treatment option was available for me. I think it can save a lot of people’s lives.”
Alberta Health Services is the provincial health authority responsible for planning and delivering health supports and services for more than four million adults and children living in Alberta. Our mission is to provide a patient-focused, quality health system that is accessible and sustainable for all Albertans. Our current focus is on reducing emergency department wait-times, improving EMS response times, increasing access to surgeries, and improving patient flow.
