Endoscopy 2011; 43(4): 282-290
DOI: 10.1055/s-0030-1256309
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Radiofrequency ablation for the endoscopic eradication of esophageal squamous high grade intraepithelial neoplasia and mucosal squamous cell carcinoma

F.  G.  I.  van Vilsteren1 , L.  Alvarez Herrero1 , 2 , R.  E.  Pouw1 , F.  J.  W.  ten Kate3 , M.  Visser3 , C.  A.  Seldenrijk5 , M.  I.  van Berge Henegouwen4 , B.  L.  Weusten1 , 2 , J.  J.  Bergman1
  • 1Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
  • 2Gastroenterology and Hepatology, St Antonius hospital, Nieuwegein, The Netherlands
  • 3Pathology, Academic Medical Center, Amsterdam, The Netherlands
  • 4Surgery, Academic Medical Center, Amsterdam, The Netherlands
  • 5Pathology, St Antonius hospital, Nieuwegein, The Netherlands
Further Information

Publication History

submitted 14 November 2010

accepted after revision 31 January 2010

Publication Date:
31 March 2011 (online)

Background and study aims: Radiofrequency ablation (RFA) with or without prior endoscopic resection safely and effectively removes early neoplasia in Barrett's esophagus. We speculated that this approach might also be suited for early squamous neoplasia of the esophagus. The aim of the study was to assess our initial experiences with RFA for high grade intraepithelial neoplasia (HGIN) and esophageal squamous cell cancer (ESCC) limited to the mucosa.

Patients and methods: This was a prospective case series study in two tertiary centers. Patients with at least one unstained lesion (USL) of the esophagus using Lugol's chromoendoscopy and squamous HGIN/ESCC upon biopsy were included. In the case of nonflat USLs, endoscopic resection was performed for staging and to render the mucosa flat. After endoscopic resection and subsequent circumferential RFA, chromoendoscopy was repeated every 3 months with focal RFA of residual USLs. Follow-up chromoendoscopy was repeated at 6 months and annually thereafter. The main outcome measure was complete histological response for any squamous intraepithelial neoplasia or ESCC.

Results: A total of 13 patients (10 HGIN, three ESCC) were included. Following endoscopic resection in nine patients, the median extent of USLs was 4 cm and 50 % of circumference. All 13 patients achieved a complete response after a median of 2 RFA sessions (IQR 1 – 3 sessions). RFA-related complications included two mucosal lacerations (at the endoscopic resection scar) and one intramural hematoma, none requiring therapy. Endoscopic resection-/RFA-related complications were three stenoses. Dilation resulted in perforation in one patient (managed with a covered stent). There were no recurrences (median follow-up 17 months [IQR 11 – 22 months]).

Conclusions: This study suggests that RFA with or without prior endoscopic resection for esophageal squamous HGIN and mucosal ESCC is feasible and effective.

References

J. BergmanMD, PhD 

Department of Gastroenterology and Hepatology
Academic Medical Center

Meibergdreef 9
1105 AZ Amsterdam
The Netherlands

Fax: +31-20-6917033

Email: j.j.bergman@amc.uva.nl

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