Table 3.
Radiofrequency ablation vs cryotherapy
| Radiofrequency ablation | Cryotherapy | |
| Mechanism of action | Bipolar electrode delivering radiofrequency energy to mucosa which generates heat and causes a uniform thermal injury on contact | Rapid freeze and thaw cycles cause immediate effects of slowing cellular metabolism and freezing intracellular water. Subsequently, ice formation results in disruption of cellular membranes and organelle dysfunction and eventually cellular apoptosis. |
| Maximal depth of injury | Mucosa (500-1000 microns) | Depends on the dose delivered; upto submucosa |
| Eradication of metaplasia | 66.7%-100 % | 41.3%-60% with cryospray; 84%-100% with cryoballoon |
| Eradication of dysplasia | 87.5%-100% | 78.8%-90% with cryospray; 92%-100% with cryoballoon |
| Post procedure pain requiring analgesics | 4 d | 2 d |
| Side effects | Esophageal strictures in 10.2%, bleeding 1.1%, perforation 0.2% | Esophageal strictures in 0%-12.5%, bleeding in 2 cases, perforation in 3 cases |
| Durability | CE-D 98% and CE-IM 91% at 3 yr | CE-D 92%, and CE-IM 81% at 5 yr (with cryospray only, cryoballoon data not available) |
| Recurrent metaplasia | 16.10% | 13.30% |
| Recurrent dysplasia | 2.60% | 3.60% |
| Recurrent high grade dysplasia or cancer | 1.40% | 1.30% |
CE-D: Complete eradication of dysplasia; CE-IM: Complete eradication of intestinal metaplasia.