Endoscopic radiofrequency ablation for early esophageal squamous cell neoplasia: Report of safety and effectiveness from a large prospective trial

Shun He, Jacques Bergman, Yueming Zhang, Bas Weusten, Liyan Xue, Xiumin Qin, Lizhou Dou, Yong Liu, David Fleischer, Ning Lu, Sanford M. Dawsey, Gui Qi Wang

Research output: Contribution to journalArticle

29 Scopus citations

Abstract

Background and study aims: Endoscopic radiofrequency ablation (RFA) is an established therapy for Barrett's esophagus. Preliminary reports, limited by low patient numbers, also suggest a possible role for RFA in early esophageal squamous cell neoplasia (ESCN). The aim of this study was to evaluate the safety and effectiveness of RFA for early ESCN (moderate/high grade intraepithelial neoplasia [MGIN/HGIN] and early flat-type esophageal squamous cell carcinoma [ESCC]). Patients and methods: This prospective cohort study included patients with at least one flat (type 0-IIb) unstained lesion (USL) on Lugol's chromoendoscopy and a consensus diagnosis of MGIN, HGIN, or early ESCC. RFA was used at baseline to treat all USLs, and then biopsy (and focal RFA if USL persisted) was performed every 3 months until all biopsies were negative for MGIN, HGIN, and ESCC. The main outcome measurements were complete response at 3 and 12 months (absence of MGIN, HGIN, and ESCC), neoplastic progression, and adverse events. Results: A total of 96 patients participated (MGIN 45, HGIN 42, early ESCC 9). At 3 and 12 months, 73% (70/96) and 84% (81/96), respectively, showed a complete response. Two patients (2%) progressed (MGIN to HGIN; HGIN to T1m2 ESCC); both were treated endoscopically and achieved complete response. Stricture occurred in 20 patients (21%), all after circumferential RFA. Lugol's +RFA 12J/cm2 (single application, no cleaning) was the favored baseline circumferential RFA technique (82% 12-month complete response [14/17], 6% stricture [6/17]). Conclusion: In patients with early ESCN, RFA was associated with a high complete response rate and an acceptable safety profile.

Original languageEnglish (US)
Pages (from-to)398-408
Number of pages11
JournalEndoscopy
Volume47
Issue number5
DOIs
StatePublished - May 1 2015

ASJC Scopus subject areas

  • Gastroenterology

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    He, S., Bergman, J., Zhang, Y., Weusten, B., Xue, L., Qin, X., Dou, L., Liu, Y., Fleischer, D., Lu, N., Dawsey, S. M., & Wang, G. Q. (2015). Endoscopic radiofrequency ablation for early esophageal squamous cell neoplasia: Report of safety and effectiveness from a large prospective trial. Endoscopy, 47(5), 398-408. https://doi.org/10.1055/s-0034-1391285