Outcomes from a prospective trial of endoscopic radiofrequency ablation of early squamous cell neoplasia of the esophagus

Jacques J.G.H.M. Bergman, Yue Ming Zhang, Shun He, Bas Weusten, Liyan Xue, David E. Fleischer, Ning Lu, Sanford M. Dawsey, Gui Qi Wang

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66 Scopus citations

Abstract

Background: Radiofrequency ablation (RFA) is safe and effective for eradicating neoplasia in Barrett's esophagus. Objective: To evaluate RFA for eradicating early esophageal squamous cell neoplasia (ESCN) defined as moderate-grade squamous intraepithelial neoplasia (MGIN) and high-grade squamous intraepithelial neoplasia (HGIN) and early flat-type esophageal squamous cell carcinoma (ESCC). Design: Prospective cohort study. Setting: Tertiary referral center. Patients: Esophageal unstained lesions (USLs) were identified using Lugol's chromoendoscopy. Inclusion criteria were at least 1 flat (type 0-IIb) USL 3 cm or larger, USL-bearing esophagus 12 cm or less, and a consensus diagnosis of MGIN, HGIN, or ESCC by 2 expert GI pathologists. Exclusion criteria were previous endoscopic resection or ablation, stricture, or any nonflat mucosa. Interventions: Circumferential RFA creating a continuous treatment area (TA) including all USLs. At 3-month intervals thereafter, chromoendoscopy with biopsies followed by focal RFA of USLs, if present. Main Outcome Measurements: Complete response (CR) at 12 months defined as absence of MGIN, HGIN, or ESCC in the TA, CR after 1 RFA session, neoplastic progression from baseline, and adverse events. Results: Twenty-nine patients (14 male, mean age 60.3 years) with MGIN (n = 18), HGIN (n = 10), or ESCC (n = 1) participated. Mean USL length was 6.2 cm (TA 8.2 cm). At 3 months after 1 RFA session, 86% of patients (25/29) had a CR. At 12 months, 97% of patients (28/29) had a CR. There was no neoplastic progression. There were 4 strictures, all dilated to resolution. Limitations: Single-center study with limited number of patients. Conclusions: In patients with early ESCN (MGIN, HGIN, flat-type ESCC), RFA was associated with a high rate of histological complete response (97% of patients), no neoplastic progression, and an acceptable adverse event profile.

Original languageEnglish (US)
Pages (from-to)1181-1190
Number of pages10
JournalGastrointestinal endoscopy
Volume74
Issue number6
DOIs
StatePublished - Dec 1 2011

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ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Bergman, J. J. G. H. M., Zhang, Y. M., He, S., Weusten, B., Xue, L., Fleischer, D. E., Lu, N., Dawsey, S. M., & Wang, G. Q. (2011). Outcomes from a prospective trial of endoscopic radiofrequency ablation of early squamous cell neoplasia of the esophagus. Gastrointestinal endoscopy, 74(6), 1181-1190. https://doi.org/10.1016/j.gie.2011.05.024