What is Spray Cryotherapy?Cryotherapy is the spraying of a cooled liquid (liquid nitrogen) onto the unwanted tissue in the esophagus. Because freezing, unlike heat therapies, does not burn tissue, the underlying cell structure is preserved, and new tissue will regrow where the diseased tissue has been frozen and sloughed off with little to no scarring. This type of liquid nitrogen cryotherapy is also commonly used in the office by dermatologists to get rid of unwanted areas on the skin. Spray cryotherapy for Barrett’s esophagus is performed on an outpatient basis by a gastroenterologist. Under the care of an anesthesiologist, the patient will receive either deep sedation or general anesthesia, and the spray is administered through a small scope (endoscope).

761753 Rev A.

Spray Cryotherapy for Esophageal Disease

“ I have been fighting esophageal cancer for 7 years and have undergone esophagectomy, radiation and chemotherapy. Each of these measures stopped the cancer for a while, but the cancer has come back. My doctor recommended that I try spray cryotherapy to provide palliative care for my cancer given that I am 81 years old and unable to tolerate these aggressive treatments again. I have been having treatments for the past year and I am pleased to say that my tumor has shrunk significantly. I believe that my doctors and spray cryotherapy have added quality years to my life.”

-Don D. (Bethlehem, PA)

3. Trindade et al, “Liquid Nitrogen Spray Cryotherapy is Associated with Less Postprocedural Pain than Radiofrequency Ablation in Barrett’s Esophagus,” Journal of Clinical Gastroenerology, Jan 2018, www.jcge.com

Spray Cryotherapy (truFreeze®)

Spray Cryotherapy (truFreeze®)

RFA Focal ablation

RFA Circumferential ablation

Spray cryotherapy is less painful than other commonly used ablation methods, in a study examining patient pain after an esophageal ablation procedure.3

3.5

3

2.5

2

1.5

1

0.5

0Pain Immediately After Procedurewith truFreeze®

Pain After 48 Hours with truFreeze®

Pain Immediately After Procedure

with RFA

Pain After 48 Hours with RFA

© 2020 STERIS Endoscopy or its affiliates. All rights reserved.Unless otherwise indicated, all marks denoted with ® or ™ are registered with theU.S. Patent and Trademark Office, or are trademarks owned by STERIS or its affiliates.Images shown are photographic models, not actual customer images.

STERIS 5960 Heisley RoadMentor, OH 44060-1834 – USACustomer Service: 800-548-4873Fax: 440-639-4495

www.steris.com

What is Barrett’s Esophagus?Barrett’s Esophagus is a precancerous condition predominantly seen in patients with longstanding acid reflux disease. Approximately 12 million Americans suffer from this condition. In patients with Barrett’s Esophagus, the lining of the esophagus - the food pipe that connects the mouth to the stomach – is replaced by abnormal tissue. Risk factors that can lead to the development of Barrett’s Esophagus include longstanding heartburn, gastroesophageal reflux disease (GERD), obesity, age, ethnicity (more common in Caucasians), gender (more prevalent among males) and a history of smoking. This damage can result in inflammation that causes the cells to become altered. This condition can some-times lead to esophageal cancer. It is important that patients seek treatment from their physician when they experience these symptoms.

Esophageal Cancer RiskIn the United States, esophageal cancer is the seventh -leading cause of cancer death among males (approximately 4% of the total). In recent decades, incidence of esophageal cancers (which is associated with Barrett’s esophagus) has risen steadily in the United States.1

The long-term erosive effects of acid reflux (an extremely common condition, also known as gastroesophageal reflux disease or GERD) have been strongly linked to this type of cancer.2

How Does the Procedure Work?During cryotherapy a thin, flexible tube (endoscope) is inserted through the mouth and into the esophagus, the tube that connects the mouth to the stomach. The tip of the flexible scope has a lens and a light source, which allow images to be sent to a monitor for close inspection of the lining of the upper gastrointestinal tract. During the procedure, the physician will insert a special catheter (small tube) into the endoscope and spray liquid nitrogen through it to freeze the unwanted tissue. The tissue is sprayed, kept frozen for a period of time, then allowed to thaw. This cycle is repeated a few times at each site in your esophagus identified by your physician.

Preparing for the procedureYou should follow the instructions specified by your doctor or their staff. The following instructions are provided as an example of what you can expect. No eating or drinking after midnight the day before your procedure. Arrange to have someone drive you home after the procedure.

If you take aspirin or blood thinning medication, you will receive instructions from your doctor about whether you should stop taking this medication and if so, when to stop taking them before an endoscopy.

Day of the procedure:The procedure will be performed using an endoscope. The procedure time will depend on the complexity of your case. You will be monitored for a time after your procedure.

After the procedure: Follow the discharge instructions provided by your physician and their staff after the procedure. You may experience mild discomfort after the procedure. Restrict your eating to soft foods for the first 24 hours after the procedure, as your esophagus is healing. Your physician will schedule a follow-up appointment within two to three months following the procedure. Regular monitoring with endoscopies and biopsies are recommended after cryotherapy ablation. 1. Conteduca V, Sansonna D, Ingravallo G, Marangi S, Russi S, Lauletta G, Dammacco F (August 2012)

Barretts esophagus and esophageal cancer: an overview” International Journal of Oncology 41(2)414-24.2. de Jonge, PJ; van Blankenstein, M; Grady, WM; Kuipers, EJ (January 2014). “Barrett’s

oesophagus: epidemiology, cancer risk and implications for management.” Gut. 63 (1): 191–202. doi:10.1136/gutjnl-2013-305490. PMID 24092861. Archived from the original on 2014-01-07.

Endoscopic image demonstrating Barrett’s esophagus being treated with cryotherapy.

Endoscopic image showing an area just treated with cryotherapy. The white area is frozen.

What is Barrett’s Esophagus?Barrett’s Esophagus is a precancerous condition predominantly seen in patients with longstanding acid reflux disease. Approximately 12 million Americans suffer from this condition. In patients with Barrett’s Esophagus, the lining of the esophagus - the food pipe that connects the mouth to the stomach – is replaced by abnormal tissue. Risk factors that can lead to the development of Barrett’s Esophagus include longstanding heartburn, gastroesophageal reflux disease (GERD), obesity, age, ethnicity (more common in Caucasians), gender (more prevalent among males) and a history of smoking. This damage can result in inflammation that causes the cells to become altered. This condition can some-times lead to esophageal cancer. It is important that patients seek treatment from their physician when they experience these symptoms.

Esophageal Cancer RiskIn the United States, esophageal cancer is the seventh -leading cause of cancer death among males (approximately 4% of the total). In recent decades, incidence of esophageal cancers (which is associated with Barrett’s esophagus) has risen steadily in the United States.1

The long-term erosive effects of acid reflux (an extremely common condition, also known as gastroesophageal reflux disease or GERD) have been strongly linked to this type of cancer.2

How Does the Procedure Work?During cryotherapy a thin, flexible tube (endoscope) is inserted through the mouth and into the esophagus, the tube that connects the mouth to the stomach. The tip of the flexible scope has a lens and a light source, which allow images to be sent to a monitor for close inspection of the lining of the upper gastrointestinal tract. During the procedure, the physician will insert a special catheter (small tube) into the endoscope and spray liquid nitrogen through it to freeze the unwanted tissue. The tissue is sprayed, kept frozen for a period of time, then allowed to thaw. This cycle is repeated a few times at each site in your esophagus identified by your physician.

Preparing for the procedureYou should follow the instructions specified by your doctor or their staff. The following instructions are provided as an example of what you can expect. No eating or drinking after midnight the day before your procedure. Arrange to have someone drive you home after the procedure.

If you take aspirin or blood thinning medication, you will receive instructions from your doctor about whether you should stop taking this medication and if so, when to stop taking them before an endoscopy.

Day of the procedure:The procedure will be performed using an endoscope. The procedure time will depend on the complexity of your case. You will be monitored for a time after your procedure.

After the procedure: Follow the discharge instructions provided by your physician and their staff after the procedure. You may experience mild discomfort after the procedure. Restrict your eating to soft foods for the first 24 hours after the procedure, as your esophagus is healing. Your physician will schedule a follow-up appointment within two to three months following the procedure. Regular monitoring with endoscopies and biopsies are recommended after cryotherapy ablation. 1. Conteduca V, Sansonna D, Ingravallo G, Marangi S, Russi S, Lauletta G, Dammacco F (August 2012)

Barretts esophagus and esophageal cancer: an overview” International Journal of Oncology 41(2)414-24.2. de Jonge, PJ; van Blankenstein, M; Grady, WM; Kuipers, EJ (January 2014). “Barrett’s

oesophagus: epidemiology, cancer risk and implications for management.” Gut. 63 (1): 191–202. doi:10.1136/gutjnl-2013-305490. PMID 24092861. Archived from the original on 2014-01-07.

Endoscopic image demonstrating Barrett’s esophagus being treated with cryotherapy.

Endoscopic image showing an area just treated with cryotherapy. The white area is frozen.

What is Barrett’s Esophagus?Barrett’s Esophagus is a precancerous condition predominantly seen in patients with longstanding acid reflux disease. Approximately 12 million Americans suffer from this condition. In patients with Barrett’s Esophagus, the lining of the esophagus - the food pipe that connects the mouth to the stomach – is replaced by abnormal tissue. Risk factors that can lead to the development of Barrett’s Esophagus include longstanding heartburn, gastroesophageal reflux disease (GERD), obesity, age, ethnicity (more common in Caucasians), gender (more prevalent among males) and a history of smoking. This damage can result in inflammation that causes the cells to become altered. This condition can some-times lead to esophageal cancer. It is important that patients seek treatment from their physician when they experience these symptoms.

Esophageal Cancer RiskIn the United States, esophageal cancer is the seventh -leading cause of cancer death among males (approximately 4% of the total). In recent decades, incidence of esophageal cancers (which is associated with Barrett’s esophagus) has risen steadily in the United States.1

The long-term erosive effects of acid reflux (an extremely common condition, also known as gastroesophageal reflux disease or GERD) have been strongly linked to this type of cancer.2

How Does the Procedure Work?During cryotherapy a thin, flexible tube (endoscope) is inserted through the mouth and into the esophagus, the tube that connects the mouth to the stomach. The tip of the flexible scope has a lens and a light source, which allow images to be sent to a monitor for close inspection of the lining of the upper gastrointestinal tract. During the procedure, the physician will insert a special catheter (small tube) into the endoscope and spray liquid nitrogen through it to freeze the unwanted tissue. The tissue is sprayed, kept frozen for a period of time, then allowed to thaw. This cycle is repeated a few times at each site in your esophagus identified by your physician.

Preparing for the procedureYou should follow the instructions specified by your doctor or their staff. The following instructions are provided as an example of what you can expect. No eating or drinking after midnight the day before your procedure. Arrange to have someone drive you home after the procedure.

If you take aspirin or blood thinning medication, you will receive instructions from your doctor about whether you should stop taking this medication and if so, when to stop taking them before an endoscopy.

Day of the procedure:The procedure will be performed using an endoscope. The procedure time will depend on the complexity of your case. You will be monitored for a time after your procedure.

After the procedure: Follow the discharge instructions provided by your physician and their staff after the procedure. You may experience mild discomfort after the procedure. Restrict your eating to soft foods for the first 24 hours after the procedure, as your esophagus is healing. Your physician will schedule a follow-up appointment within two to three months following the procedure. Regular monitoring with endoscopies and biopsies are recommended after cryotherapy ablation. 1. Conteduca V, Sansonna D, Ingravallo G, Marangi S, Russi S, Lauletta G, Dammacco F (August 2012)

Barretts esophagus and esophageal cancer: an overview” International Journal of Oncology 41(2)414-24.2. de Jonge, PJ; van Blankenstein, M; Grady, WM; Kuipers, EJ (January 2014). “Barrett’s

oesophagus: epidemiology, cancer risk and implications for management.” Gut. 63 (1): 191–202. doi:10.1136/gutjnl-2013-305490. PMID 24092861. Archived from the original on 2014-01-07.

Endoscopic image demonstrating Barrett’s esophagus being treated with cryotherapy.

Endoscopic image showing an area just treated with cryotherapy. The white area is frozen.

What is Spray Cryotherapy?Cryotherapy is the spraying of a cooled liquid (liquid nitrogen) onto the unwanted tissue in the esophagus. Because freezing, unlike heat therapies, does not burn tissue, the underlying cell structure is preserved, and new tissue will regrow where the diseased tissue has been frozen and sloughed off with little to no scarring. This type of liquid nitrogen cryotherapy is also commonly used in the office by dermatologists to get rid of unwanted areas on the skin. Spray cryotherapy for Barrett’s esophagus is performed on an outpatient basis by a gastroenterologist. Under the care of an anesthesiologist, the patient will receive either deep sedation or general anesthesia, and the spray is administered through a small scope (endoscope).

761753 Rev A.

Spray Cryotherapy for Esophageal Disease

“ I have been fighting esophageal cancer for 7 years and have undergone esophagectomy, radiation and chemotherapy. Each of these measures stopped the cancer for a while, but the cancer has come back. My doctor recommended that I try spray cryotherapy to provide palliative care for my cancer given that I am 81 years old and unable to tolerate these aggressive treatments again. I have been having treatments for the past year and I am pleased to say that my tumor has shrunk significantly. I believe that my doctors and spray cryotherapy have added quality years to my life.”

-Don D. (Bethlehem, PA)

3. Trindade et al, “Liquid Nitrogen Spray Cryotherapy is Associated with Less Postprocedural Pain than Radiofrequency Ablation in Barrett’s Esophagus,” Journal of Clinical Gastroenerology, Jan 2018, www.jcge.com

Spray Cryotherapy (truFreeze®)

Spray Cryotherapy (truFreeze®)

RFA Focal ablation

RFA Circumferential ablation

Spray cryotherapy is less painful than other commonly used ablation methods, in a study examining patient pain after an esophageal ablation procedure.3

3.5

3

2.5

2

1.5

1

0.5

0Pain Immediately After Procedurewith truFreeze®

Pain After 48 Hours with truFreeze®

Pain Immediately After Procedure

with RFA

Pain After 48 Hours with RFA

© 2020 STERIS Endoscopy or its affiliates. All rights reserved.Unless otherwise indicated, all marks denoted with ® or ™ are registered with theU.S. Patent and Trademark Office, or are trademarks owned by STERIS or its affiliates.Images shown are photographic models, not actual customer images.

STERIS 5960 Heisley RoadMentor, OH 44060-1834 – USACustomer Service: 800-548-4873Fax: 440-639-4495

www.steris.com

What is Spray Cryotherapy?Cryotherapy is the spraying of a cooled liquid (liquid nitrogen) onto the unwanted tissue in the esophagus. Because freezing, unlike heat therapies, does not burn tissue, the underlying cell structure is preserved, and new tissue will regrow where the diseased tissue has been frozen and sloughed off with little to no scarring. This type of liquid nitrogen cryotherapy is also commonly used in the office by dermatologists to get rid of unwanted areas on the skin. Spray cryotherapy for Barrett’s esophagus is performed on an outpatient basis by a gastroenterologist. Under the care of an anesthesiologist, the patient will receive either deep sedation or general anesthesia, and the spray is administered through a small scope (endoscope).

761753 Rev A.

Spray Cryotherapy for Esophageal Disease

“ I have been fighting esophageal cancer for 7 years and have undergone esophagectomy, radiation and chemotherapy. Each of these measures stopped the cancer for a while, but the cancer has come back. My doctor recommended that I try spray cryotherapy to provide palliative care for my cancer given that I am 81 years old and unable to tolerate these aggressive treatments again. I have been having treatments for the past year and I am pleased to say that my tumor has shrunk significantly. I believe that my doctors and spray cryotherapy have added quality years to my life.”

-Don D. (Bethlehem, PA)

3. Trindade et al, “Liquid Nitrogen Spray Cryotherapy is Associated with Less Postprocedural Pain than Radiofrequency Ablation in Barrett’s Esophagus,” Journal of Clinical Gastroenerology, Jan 2018, www.jcge.com

Spray Cryotherapy (truFreeze®)

Spray Cryotherapy (truFreeze®)

RFA Focal ablation

RFA Circumferential ablation

Spray cryotherapy is less painful than other commonly used ablation methods, in a study examining patient pain after an esophageal ablation procedure.3

3.5

3

2.5

2

1.5

1

0.5

0Pain Immediately After Procedurewith truFreeze®

Pain After 48 Hours with truFreeze®

Pain Immediately After Procedure

with RFA

Pain After 48 Hours with RFA

© 2020 STERIS Endoscopy or its affiliates. All rights reserved.Unless otherwise indicated, all marks denoted with ® or ™ are registered with theU.S. Patent and Trademark Office, or are trademarks owned by STERIS or its affiliates.Images shown are photographic models, not actual customer images.

STERIS 5960 Heisley RoadMentor, OH 44060-1834 – USACustomer Service: 800-548-4873Fax: 440-639-4495

www.steris.com