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Endoscopic cryotherapy:Indications,techniques,and outcomes involving the gastrointestinal tract

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World Journal of Gastrointestinal Endoscopy 2022年第1期14卷 17-28页

作者： Amaninder Dhaliwal Syed M Saghir Harmeet S Mashiana Annie Braseth Banreet S Dhindsa Daryl Ramai Pushpak Taunk Rene Gomez-Esquivel Aamir Dam Jason Klapman Douglas G Adler Division of Gastroenterology and Advanced Endoscopy McLeod Regional Medical CenterFlorenceSC 29501United States Division of Gastroenterology Creighton University School of MedicineOmahaNE 68124United States Division of Gastroenterology and Hepatology University of Nebraska Medical CenterOmahaNE 68198-2000United States Division of Gastroenterology University of IowaIowa CityIA 52242-1009United States Division of Gastroenterology and Hepatology University of Utah School of MedicineSalt Lake CityUT 84132United States Division of Gastroenterology USF HealthTampaFL 33612United States Division of Gastroenterology and Hepatology Moffitt Cancer CenterTampaFL 33612United States Gastrointestinal Tumor Program Moffitt Cancer CenterTampaFL 33612United States Center for Advanced Therapeutic Endoscopy Porter Adventist HospitalCenter HealthDenverCO 80210United States

Endoscopic cryotherapy is a technique utilized for the ablation of target tissue within the gastrointestinal tract.A cryotherapy system utilizes the endoscopic application of cryogen such as liquid nitrogen,carbon dioxide or liquid nitrous oxide.This leads to disruption of cell membranes,apoptosis,and thrombosis of local blood vessels within the target tissue.Several trials utilizing cryotherapy for Barrett’s esophagus(BE)with variable dysplasia,gastric antral vascular ectasia(GAVE),esophageal carcinoma,radiation proctitis,and metastatic esophageal carcinomas have shown safety and efficacy.More recently,liquid nitrogen cryotherapy(cryodilation)was shown to be safe and effective for the treatment of a benign esophageal stricture which was refractory to dilations,steroid injections,and stenting.Moreover,liquid nitrogen cryotherapy is associated with less post procedure pain as compared to radiofrequency ablation in BE with comparable ablation rates.In patients with GAVE,cryotherapy was found to be less tedious as compared to argon plasma coagulation.Adverse events from cryotherapy most commonly include chest pain,esophageal strictures,and bleeding.Gastric perforations did occur as well,but less often.In summary,endoscopic cryotherapy is a promising and growing field,which was first demonstrated in BE,but the use now spans for several other disease processes.Larger randomized controlled trials are needed before its role can be established for these different diseases.

关键词： cryotherapy Gastric antral vascular ectasia Barrett’s esophagus Esophageal cancer Palliative therapy

cryotherapy versus Hydrogen Peroxide in the Treatment of Seborrheic Keratosis

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Journal of Cosmetics, Dermatological Sciences and Applications 2023年第1期13卷 62-75页

作者： Al-Sadat Mosbeh Ahmed Aladl Department of Dermatology Faculty of Medicine Al-Azhar University Cairo Egypt

Seborrheic keratosis has a varying degree of pigmentation. In pigmented seborrheic keratosis, the proliferating keratinocytes trigger the activation of neighboring melanocytes by secreting melanocyte-stimulating cytokines. The etiology of seborrheic keratosis is not known. Epidermal growth factors or their receptors have been implicated in the development of seborrheic keratosis. Seborrheic keratoses can safely be left alone, but ugly or easily traumatized ones can be removed with cryotherapy, electrodesiccation, curettage, or shave excision. The present work aims to compare two modalities of treatment for seborrheic keratosis, namely cryotherapy and hydrogen peroxide (30%). Methods: 30 patients with seborrheic keratosis were included in this study. They were divided into two groups, each with 15 patients. The treatment modalities that have been used include cryotherapy and hydrogen peroxide in three different concentrations (30%, 35%, and 40%). Result: The cryotherapy group consisted of 15 patients, 7 males and 8 females. Their ages ranged from 38 to 80 years, with a mean of 56.1 ± 11.4. Clinical and photographic assessments showed complete removal in all 15 patients in this group (100%). As regards the hydrogen peroxide group, this group included 15 patients, distributed among 7 males and 8 females. Their ages ranged from 39 to 90 years, with a mean of 53.9 ± 14.4. Clinical and photographic assessments showed response in only one small superficial lesion in one patient (6.7%) and no response in 14 patients (93.3%). Conclusion: cryotherapy is an effective, easy, and relatively cheap method for treating seborrheic keratosis.

关键词： Seborrheic Keratosis cryotherapy Hydrogen Peroxide

Simultaneous pars plana vitrectomy,panretinal photocoagulation,cryotherapy,and Ahmed valve implantation for neovascular glaucoma

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International Journal of Ophthalmology(English edition) 2021年第9期14卷 1396-1401页

作者： Carolina Bernal-Morales Marina Dotti-Boada Alvaro Olate-Perez Manuel J.Navarro-Angulo Laura Pelegrín Marc Figueras-Roca Institut Clínic d’Oftalmologia(ICOF) Hospital ClínicBarcelona 08028Spain August Pi i Sunyer Biomedical Research Institute(IDIBAPS) Barcelona 08028Spain

AIM:To describe and evaluate the efficacy of Ahmed glaucoma valve implantation(AGV)combined with pars plana vitrectomy(PPV)in a single surgical act for the treatment of advanced neovascular glaucoma(NVG).METHODS:Retrospective observational case series included 51 eyes from 50 patients with severe NVG treated with PPV,AGV,and panretinal photocoagulation and/or cryotherapy in a single surgical act during a 13-year period(2005-2018).Preoperative,intraoperative and postoperative data at day 1 and months 1,3,6,21,and 24 were systematically collected.Definition of surgical success was stablished at IOP between 6 and 21 mm Hg with or without topical treatment.RESULTS:Main indications for surgery were NVG secondary to proliferative diabetic retinopathy(39.2%)and central retinal vein occlusion(37.3%).Mean(±SD)preoperative IOP was 42.0±11.2 mm Hg decreasing to 15.5±7.1 mm Hg at 12 mo and 15.8±9.1 mm Hg at 24 mo of follow up.Cumulative incidence of success of IOP control was 76.0%at first postoperative month,reaching 88.3%at 6 mo.Prevalence of successful IOP control at long term was 74.4%at 12 mo and 71.4%at 24 mo.Eye evisceration for unsuccessful NVG management was required in 1 case(2.0%).CONCLUSION:Combination of AGV implantation and PPV in a single act may be a suitable option for severe forms of NVG in a case-by-case basis for effective IOP control and a complete panretinal photocoagulation.

关键词： neovascular glaucoma Ahmed valve pars plana vitrectomy panretinal photocoagulation cryotherapy

Comparison of encirclage and cryotherapy with argon laser in the management of traumatic cyclodialysis cleft

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International Journal of Ophthalmology(English edition) 2019年第1期12卷 165-168页

作者： Gitanjli Sood Vinata Rajendran Ronnie George Tarun Sharma Rajiv Raman Shri Bhagawan Mahavir Vitreo Retinal Services Sankara Nethralaya Department of Glaucoma Medical Research FoundationSankara NethralayaChennai

The study compared anatomical and functional outcome of a novel technique of encirclage and cryotherapy with the conventional argon laser in the management of traumatic cyclodialysis cleft in 19 patients(10: encirclage and 9: argon laser). The postoperative anatomical success was taken as rise in intraocular pressure(IOP) more than 6 mm Hg or the closure of cleft on gonioscopy or ultrasound biomicroscopy(UBM). Visual outcome was measured as change in logMAR visual acuity. Traumatic cataract and hypotony were present in majority. IOP>6 mm Hg was noted in 90% of encirclage group and in 77.70% of argon laser group. Two cases had non-closure of cleft. Encirclage is comparable to argon laser in terms of anatomical and functional success with possible advantage of single procedure and use in cases with failed laser.

关键词： traumatic cyclodialysis encirclage cryotherapy laser hypotony

The effect of cryotherapy application before versus after subcutaneous anticoagulant injection on pain intensity and hematoma formation: A quasi-experimental design

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International Journal of Nursing Sciences 2018年第3期5卷 223-229页

作者： Dalia Salah El-Deen Naglaa F.A.Youssef Medical-Surgical Nursing Department Faculty of NursingCairo UniversityEgypt Medical-Surgical Nursing Department College of NursingPrincess Nourah bint Abdulrahman UniversityKingdom of Saudi Arabia

Objective:To investigate the effect of cryotherapy application before versus after subcutaneous anticoagulant injection(SCAI)on pain intensity and hematoma formation.Methods:A quasi-experimental design was utilized.A convenient sample of 105 adult patients,who were admitted to one of the biggest teaching hospitals in Cairo and receiving SCAI,were recruited over a period of six months.Patients were randomly allocated into three groups:A Control group who received the routine hospital care(G1,n=35)and two intervention group who received cryotherapy for 5-min(G2:cryotherapy applied before SCAI,n=35;G3:cryotherapy applied after SCAI,n=35).Demographic and medical history data sheet,Pain Numeric Rating Scale and Hematoma Formation and Size Assessment Scale were used to collect the data.Results:The pain intensity among the patients in the two intervention groups(G2:Median=1.0;G3:Median=0)was significantly lower than in the control group(G1,Median=3.0).No significant difference was found between G2 and G3(P=0.728).Applying cryotherapy after SCAI(G3)decreased the frequency of hematoma formation(48hrs=31.4%&72hrs=28.5%)compared to applying it before injection(G2,100%)or not applying it(G1,100%).The size of hematoma in G3 was smaller than that in G2(Pcryotherapy significantly decreased pain intensity and hematoma occurrence/size.Applying cryotherapy after injection was more effective in preventing hematoma formation and decreasing its size than applying it before injection.

关键词： Anticoagulants cryotherapy Hematoma Injections Subcutaneous Pain

effective treatment of post-intubation subglottic stenosis in children with holmium laser therapy and cryotherapy via flexible bronchoscopy

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Pediatric Investigation 2019年第1期3卷 9-16页

作者： Anxia Jiao Fang Liu Andrew D.Lerner Xiaochun Rao Yan Guo Chenfang Meng Yuena Pan Gan Li Zheng Li Fang Wang Jing Zhao Yuyan Ma Xicheng Liu Xin Ni Kunling Shen Interventional Pulmonology Department Beijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina China National Clinical Research Center for Respiratory Diseases BeijingChina Division of Pulmonary and Critical Care Medicine Johns Hopkins University School of MedicineBaltimoreMDUSA Respiratory Department Beijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina Pediatric Intensive Care Unit Beijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina Department of Anesthesiology Beijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina Department of Otolaryngology Head and Neck SurgeryBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck SurgeryMOE Key Laboratory of Major Disease in ChildrenBeijing Pediatric Research InstituteBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina

Importance:Post-intubation subglottic stenosis(SGS)in children can be life threatening.Definitive treatment varies and lacks a universally accepted approach.Objective:We performed a prospective study to assess the safety and feasibility of holmium laser combined with cryotherapy delivered via flexible bronchoscopy for the treatment of post-intubation SGS in children.Methods:This study involved all patients with post-intubation SGS seen at the Interventional Pulmonology Department of Beijing Children's Hospital between July 2014 and December 2016.Holmium laser treatment and cryotherapy was then performed under flexible bronchoscopy,whose parents refused to accept the alternative standard treatment of tracheotomy and balloon dilation under direct laryngoscopy.results:Sixteen patients with post-intubation SGS were included in this study.Ages ranged from 2 months to 12.25 years old.According to the Cotton-Myer grading system,three cases were Grade II,12 cases were Grade III,and one case was Grade IV.According to the McCaffrey system,eight cases were Stage 1,two cases were Stage 2,and six cases were Stage 3.The average number of procedures was 4.88.Fifteen of the 16 patients achieved clinical cure.One patient achieved clinical improvement.The average treatment course duration was 55.31 days.No severe complications were seen.Post-treatment clinical symptoms,endoscopic findings and quality of life showed marked improvement.Interpretation:Our study supports the conclusion that holmium laser treatment combined with cryotherapy via flexible bronchoscopy appears to be a safe and feasible treatment for post-intubation SGS in children.

关键词： Subglottic stenosis Flexible bronchoscopy Holmium laser cryotherapy Children

Effect of cryotherapy on pain management at the puncture site of arteriovenous fistula among children undergoing hemodialysis

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International Journal of Nursing Sciences 2017年第1期4卷 46-51页

作者： Azza Abdel Moghny Attia Asmaa Mahfouz Hassan Faculty of Nursing Cairo-University11562Egypt

Objective: To evaluate the effectiveness of cryotherapy in managing the pain at the puncture site of Arterio-Venous Fistula (AVF) among children undergoing maintenance hemodialysis (HD).Methods: A one-group pre-post quasi-experiment was performed in two HD centers affiliated with Cairo University.The experiment involved 40 children with AVF undergoing HD.Before puncturing,cryotherapy was applied using 2 cm-3 cm pieces of frozen distilled water in a plastic bag.Pain was assessed subjectively and objectively in two dialysis sessions before and after cryotherapy.A part from a physiological assessment of vital signs,pain was assessed using the Wong-Baker Faces Pain and the Observed Pain Behavior rating scales.All research ethics were applied.Results: HD had a median duration of four years,while cryotherapy had a median application time of 8.8 min.The Wong-Baker Faces Pain score and almost all observed pain behaviors significantly decreased after cryotherapy.Significant improvements were observed in respiratory rate before and after needle puncture and in oxygen saturation after needle puncture.A lower skin dryness was observed after cryotherapy (12.5%) than before cryotherapy (52.5%;p cryotherapy can effectively reduce the venipuncture pain among children with AVF undergoing maintenance HD.However,the confounding effects of distraction and the non-randomized design used must be both considered when interpreting the findings.This study recommends the use of cryotherapy in managing needle puncture pain.Further research must adopt a randomized trial design with a placebo to support further the benefits of this procedure.

关键词： Arteriovenous fistula Children cryotherapy Hemodialysis Pain assessment scales

Histological analysis and clinical observation of phrenic nerve cryotherapy following pulmonary resection

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Neural Regeneration Research 2010年第10期5卷 769-773页

作者： Yongfu Ma Yang Liu Xueliang Yang Department of Thoracic Surgery General Hospital of Chinese PLA Beijing 100853 China Department of Thoracic Surgery Shanxi Tumor Hospital Taiyuan 030013 Shanxi Province China

BACKGROUND： Residual postoperative pleural spaces （RPPS） are often encountered during pulmonary resection; this could adversely affect the outcome and prolong recovery. Nerve cryotherapy reduces postoperative complications and does not affect neural regeneration. However, it remains unclear whether nerve cryotherapy reduces RPPS occurrence following pulmonary resection.OBJECTIVE： To explore pathological changes in the phrenic nerve following exposure to -50℃ for various freezing times, and to explore the feasibility and efficacy of phrenic nerve cryotherapy following pulmonary resection based on animal experiment results.DESIGN, TIME AND SETTING： A comparative animal study was conducted at the Animal Experimental Center of General Hospital of Chinese PLA from January to June 2008. Based on results from the animal study, a randomized, controlled, clinical study was initiated at the Department of Thoracic Surgery of General Hospital of Chinese PLA between July 2008 and July 2009.PARTICIPANTS： A total of 160 patients undergoing lobectomy were selected at the Department of Thoracic Surgery of General Hospital of Chinese PLA from July 2008 to July 2009.METHODS： Animal experiment： 27 adult goats were randomly assigned to three groups （n = 9）.The phrenic nerves were frozen at -50 ℃ for 30, 60, and 90 seconds, respectively. Clinical study： 160 patients undergoing lobectomy were randomly assigned to two groups （n = 80）. In the cryoanalgesia group, patients received phrenic nerve cryotherapy; phrenic nerves were frozen above the capsula cordis for 60 seconds at -50 ℃ prior to chest closure. Patients in the control group did not receive cryotherapy.MAIN OUTCOME MEASURES： Pathological changes were observed at days 1, 30, and 60 following phrenic nerve cryotherapy. In the clinical study, RPPS incidence rate was regularly recorded. Respiratory function tests, including measured forced vital capacity and forced expiratory volume in 1 second, were regularly conducted post-surgically. The incidence of post-surgical infection comp

关键词： lobectomy residual pleural spaces cryotherapy phrenic nerve postoperative complications neural regeneration

Advances in ablative treatment for human papillomavirus related cervical pre-cancer lesions

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Gynecology and Obstetrics Clinical Medicine 2023年第4期3卷 213-219页

作者： Lili Xu Yanming Jiang Renfeng Zhao Department of Gynecology The People's Hospital of Guangxi Zhuang Autonomous RegionGuangxi Academy of Medical SciencesNanning530021China

HPV infection is the primary cause of cervical intraepithelial neoplasia(CIN),with persistent high-risk HPV infection being the leading factor in the development of cervical cancer.In addition to the application of large loop excision of the transformation zone(LLETZ)for the treatment of cervical pre-cancerous lesions,various ablative techniques,including thermal ablation,cryotherapy,carbon dioxide(CO_(2))laser therapy,and focused ultrasound therapy also play significant roles in the management of cervical intraepithelial neoplasia.This review presents a comprehensive overview of the pathophysiology of cervical HPV infection and discusses the ablative methods commonly used in clinical practice,along with their indication and contradiction,especially in women with high-grade squamous intraepithelial lesions.The aim is to identify safe and effective treatment strategies for treating cervical intraepithelial neoplasia,thereby avoiding under-or over-treatment,which may reduce the incidenceandprogr ssion of cervical cancer through timely diagnosis and treatment.

关键词： Ablative treatment Thermal ablation cryotherapy Cervical intraepithelial neoplasia Human papillomavirus