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Endoscopy 2015; 47(05): 398-408
DOI: 10.1055/s-0034-1391285
Original article
© Georg Thieme Verlag KG Stuttgart · New York

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

Shun He   *
1   Department of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
,
Jacques Bergman   *
2   Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands
,
Yueming Zhang   *
1   Department of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
,
Bas Weusten
2   Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands
3   Department of Gastroenterology, St. Antonius Hospital, Nieuwegein, The Netherlands
,
Liyan Xue
4   Department of Pathology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
,
Xiumin Qin
1   Department of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
,
Lizhou Dou
1   Department of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
,
Yong Liu
1   Department of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
,
David Fleischer
5   Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, United States
,
Ning Lu
4   Department of Pathology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
,
Sanford M. Dawsey
6   Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States
,
Gui-Qi Wang
1   Department of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
› Author Affiliations
Further Information

Publication History

submitted 17 February 2014

accepted after revision 11 November 2014

Publication Date:
10 February 2015 (online)

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Commentaire du travail de Shun H et al., pp. 398Endoscopy 2015; 47(05): 476-476
DOI: 10.1055/s-0035-1547038

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.

* These authors contributed equally to this work.


 

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