title: Radiofrequency Ablation Versus Endoscopic Submucosal Dissection in Treating Large Early Esophageal Squamous Cell Neoplasia.
abstract: Radiofrequency ablation (RFA) and endoscopic submucosal dissection (ESD) can potentially be applied for early esophageal squamous cell neoplasia (ESCN); however, no study has directly compared these 2 modalities.We retrospectively enrolled the patients with flat-type "large" (length ≥3 cm extending ≥1/2 of the circumference of esophagus) early ESCNs treated endoscopically. The main outcome measurements were complete response at 12 months, and adverse events.Of a total of 65 patients, 18 were treated with RFA and 47 with ESD. The procedure time of RFA was significantly shorter than that of ESD (126.6 vs 34.8 min; P < 0.001). The complete resection rate of ESD and complete response rate after primary RFA were 89.3% and 77.8%, respectively. Based on the histological evaluation of the post-ESD specimens showed 14 of 47 (29.8%) had histological upstaging compared with the pre-ESD biopsies, and 4 of them had lymphovascular invasion requiring chemoradiation or surgery. After additional therapy for residual lesions, 46 (97.9%) patients in the ESD group and 17 (94.4%) patients in the RFA group achieved a complete response at 12 months. Four patients (8.5%) developed major procedure-related adverse events in the ESD group, but none in the RFA group. In patients with lesions occupying more than 3/4 of the circumference, a significantly higher risk of esophageal stenosis was noted in the ESD group compared with RFA group (83% vs 27%, P = 0.01), which required more sessions of dilatation to resolve the symptoms (median, 13 vs 3, P = 0.04). There were no procedure-related mortality or neoplastic progression in either group; however, 1 patient who received ESD and 1 who received RFA developed local recurrence during a median follow-up period of 32.4 (range, 13-68) and 18.0 (range, 13-41) months, respectively.RFA and ESD are equally effective in the short-term treatment of early flat large ESCNs; however, more adverse events occur with ESD, especially in lesions extending more than 3/4 of the circumference. RFA does not allow for pathology to evaluate the curability after ablation, and thus currently the use for invasive ESCNs should be conservative until longer follow-up studies are available.
authors.affiliation: From the Department of Internal Medicine (W-LW, C-YC, L-RM, J-TL, C-TL) and Department of Pathology, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan (I-WC); Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (C-CC, J-TL, H-PW); and School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan (J-TL).
authors.forename: Wen-Lun
authors.initials: WL
authors.lastname: Wang
authors.forename: I-Wei
authors.initials: IW
authors.lastname: Chang
authors.forename: Chien-Chuan
authors.initials: CC
authors.lastname: Chen
authors.forename: Chi-Yang
authors.initials: CY
authors.lastname: Chang
authors.forename: Lein-Ray
authors.initials: LR
authors.lastname: Mo
authors.forename: Jaw-Town
authors.initials: JT
authors.lastname: Lin
authors.forename: Hsiu-Po
authors.initials: HP
authors.lastname: Wang
authors.forename: Ching-Tai
authors.initials: CT
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D015992:Body Mass Index; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D004210:Dissection / Q000009:adverse effects / Q000379:methods*; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018307:Neoplasms, Squamous Cell / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D061646:Operative Time; D012189:Retrospective Studies; D012907:Smoking / Q000453:epidemiology