Boer LS, Nierkens S, Weusten BLAM. Applications of cryotherapy in premalignant and malignant esophageal disease: Preventing, treating, palliating disease and enhancing immunogenicity? World J Gastrointest Oncol 2025; 17(5): 103746 [DOI: 10.4251/wjgo.v17.i5.103746]
Corresponding Author of This Article
Laura Sophie Boer, MD, Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, Utrecht, Netherlands. l.s.boer-17@umcutrecht.nl
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
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 Oncol. May 15, 2025; 17(5): 103746 Published online May 15, 2025. doi: 10.4251/wjgo.v17.i5.103746
Applications of cryotherapy in premalignant and malignant esophageal disease: Preventing, treating, palliating disease and enhancing immunogenicity?
Laura Sophie Boer, Stefan Nierkens, Bas L A M Weusten
Laura Sophie Boer, Bas L A M Weusten, Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht 3584 CX, Utrecht, Netherlands
Laura Sophie Boer, Bas L A M Weusten, Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein 3435 CM, Utrecht, Netherlands
Stefan Nierkens, Department of Translational Immunology, University Medical Center Utrecht, Utrecht 3584 CX, Utrecht, Netherlands
Author contributions: Boer LS, Nierkens S, and Weusten BLAM contributed to the conception of the work and the interpretation of relevant literature; Boer LS and Nierkens S participated in the article drafting; Boer LS substantially performed the literature search and contributed to revision and figure and table preparation; Nierkens S and Weusten BLAM contributed to the revision of the article critically for important intellectual content; All authors read and approved the final version of the manuscript.
Conflict-of-interest statement: Weusten BLAM has received research funding from PENTAX Medical, C2 Therapeutics, and Aqua Medical. Boer LS is a consultant for PENTAX Medical, C2 Therapeutics.
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: Laura Sophie Boer, MD, Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, Utrecht, Netherlands. l.s.boer-17@umcutrecht.nl
Received: December 3, 2024 Revised: February 21, 2025 Accepted: April 11, 2025 Published online: May 15, 2025 Processing time: 163 Days and 18.9 Hours
Abstract
Cryotherapy is a treatment modality that uses extreme cold to destroy unwanted tissue through both immediate and delayed cellular injury. This therapy is increasingly being adopted across various medical specialties due to its minimally invasive nature and technological advancements that have been made. In the esophagus, cryotherapy is particularly utilized for the management of Barrett esophagus. It has been demonstrated to be effective and safe with potential benefits, such as a reduction in pain, over radiofrequency ablation. Additionally, it might offer a valuable alternative for patients unresponsive to radiofrequency ablation. Cryotherapy is applied for other conditions as well, including esophageal squamous cell neoplasia and malignant dysphagia. More research is needed to gain understanding of the utility in these conditions. Interestingly, cryotherapy has shown the ability to enhance the host’s immune response in reaction to antigens left in situ after treatment. While preclinical data have demonstrated promising results, the immune response is often insufficient to induce tumor regression in the clinical setting. Therefore, there is growing interest in the combination of cryotherapy and immunotherapy where ablation creates an antigen depot, and the immune system is subsequently stimulated. This combination holds promise for the future and potentially opens new doors for a breakthrough in cancer treatment.
Core Tip: Cryotherapy is an increasingly used treatment modality in the esophagus. This therapy has demonstrated safety and efficacy, particularly for Barrett esophagus though a randomized trial comparing cryotherapy to the standard treatment with radiofrequency ablation is still lacking. Interestingly the potential of cryotherapy extends far beyond Barrett esophagus with applications for a variety of other esophageal conditions and the ability to boost the immune system. Understanding the role of cryotherapy on the host’s antitumor response, both alone and in combination with immunotherapy, remains a major area of interest for future research and holds potential for significant advancements in cancer treatment.
