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

doi:10.1055/s-0034-1391285

Endoscopy, Inhaltsverzeichnis

Endoscopy 2015; 47(05): 398-408
DOI: 10.1055/s-0034-1391285

Original article

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

Shun He^*

¹Department of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China

,

Jacques Bergman^*

²Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands

,

Yueming Zhang^*

¹Department of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China

,

Bas Weusten

²Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands

³Department of Gastroenterology, St. Antonius Hospital, Nieuwegein, The Netherlands

,

Liyan Xue

⁴Department of Pathology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China

,

Xiumin Qin

¹Department of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China

,

Lizhou Dou

¹Department of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China

,

Yong Liu

¹Department of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China

,

David Fleischer

⁵Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, United States

,

Ning Lu

⁴Department of Pathology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China

,

Sanford M. Dawsey

⁶Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States

,

Gui-Qi Wang

¹Department of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China

› Institutsangaben

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 12 J/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.

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Referenzen

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