Efficacy and Safety of Focal and Multifocal Cryoballoon Ablation for Barrett's Esophagus: A Systematic Review and Meta-analysis

Background and Study Aims Cryoballoon ablation has emerged as a novel modality for the treatment of Barrett's esophagus (BE), but comprehensive evaluation of its efficacy and safety remains limited. We performed a systematic review and meta-analysis to assess the outcomes of focal and multifocal cryoballoon ablation. Methods A systematic search of the PubMed, Embase, Web of Science, and Cochrane Library databases was conducted through March 10, 2026. Studies evaluating cryoballoon ablation in adult patients with BE were included. The primary outcomes were complete eradication of intestinal metaplasia (CE-IM) and dysplasia (CE-D). Secondary outcomes included technical success and adverse events. A random-effects model was used. Results Five prospective studies involving 337 patients were analyzed. Pooled CE-IM and CE-D rates were 84% (95%CI, 72-91%; I 2 = 84.5%) and 90% (95%CI 76-96%; I 2 = 88%) in intention-to-treat analyses, increasing to 92% (95%CI 87-96%; I 2 = 55.1%) and 98% (95%CI 94-99%; I 2 = 0%) in per-protocol analyses. Technical success was 96% (95%CI 94-98%; I 2 = 52.5%). The overall stricture rate was 6% (95% CI 2-18%; I 2 = 0%), with higher rates in multifocal ablation (12%) than in focal ablation (0%). Buried Barrett's glands were rare (1%). Conclusions Cryoballoon ablation is associated with high rates of CE-IM and CE-D and a favorable safety profile in patients with BE. However, the available evidence is limited to a small number of nonrandomized studies that predominantly included short-segment, noncircumferential BE and prior endoscopic mucosal resection and were associated with substantial heterogeneity. Larger, well-designed randomized trials with longer follow-up are needed to more definitively establish its comparative effectiveness and safety relative to established ablative modalities.