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Cheng HE, Shiu SI, Ko CW. Systematic review and meta-analysis: the efficacy and safety of radiofrequency ablation for early superficial esophageal squamous cell neoplasia. BMC Gastroenterol 2024; 24:152. [PMID: 38698314 PMCID: PMC11067246 DOI: 10.1186/s12876-024-03250-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 04/29/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND AND AIM Esophageal squamous cell neoplasia (ESCN) is predominant in Asia. Endoscopic mucosal resection and endoscopic submucosal dissection (ESD) have both been recommended worldwide, however the application of endoscopic radiofrequency ablation (RFA) for treatment of early superficial ESCN remains inconclusive. We conducted a meta-analysis to study the effectiveness of RFA for early superficial ESCN. METHODS Three major bibliographic databases were reviewed for the enrollment of case series and cohort trials prior to August 23, 2023. We included adults diagnosed with early superficial ESCN who had been receiving endoscopic RFA or ESD if the treatments were available. Our focus was on the 12-month histological complete response rate (CR) and 3-month histological CR, as well as the acute and late postoperative adverse events (AEs) rate during the at follow-up periods. RESULTS Nine studies were enrolled for qualitative synthesis of narrative review, with eight trials involving a total of 447 participants for analysis. The pooled 12-month and 3-month histological CR were 0.83 (95% CI, 0.59-0.94, I2 = 80%) and 0.74 (95% CI, 0.67-0.80, I2 = 0%), respectively. As for safety, the acute and late postoperative AEs were 0.11 (95% CI, 0.05-0.26, I2 = 68%) and 0.19 (95% CI, 0.14-0.26, I2 = 0%), respectively. In subgroup analysis, the incidence of bleeding, laceration and perforation after endoscopic RFA showed 0.06, 0.06 and 0.02, respectively. When compared with ESD, RFA showed lower acute AEs and late AEs without any obvious significance. CONCLUSIONS For early superficial ESCN, endoscopic RFA achieved both higher 12-month complete remission and late complication postoperatively when compared to 3-month histological CR and acute AEs separately, while the stricture was encountered most commonly. The choice between endoscopic RFA and ESD remains inconclusive.
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Affiliation(s)
- Hsu-En Cheng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
| | - Sz-Iuan Shiu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.
- Department of Critical Care Medicine, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.
- Department of Internal Medicine, Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Chung-Wang Ko
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
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Radiofrequency Ablation for Early Superficial Flat Esophageal Squamous Cell Neoplasia: A Comprehensive Review. Gastroenterol Res Pract 2020; 2020:4152453. [PMID: 32508911 PMCID: PMC7244955 DOI: 10.1155/2020/4152453] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 04/27/2020] [Indexed: 12/17/2022] Open
Abstract
Esophageal squamous cell carcinoma comprises the majority of esophageal carcinoma in the Eastern Asia. The need of early detection of precancerous neoplastic lesions and cancer has been necessitated due to the probability of progression to the advanced stage and its poor prognosis. In recent times, many endoscopic modalities have come into practice for early detection and treatment. Endoscopic radiofrequency ablation (RFA) has been recommended as an efficient therapy in treating the dysplastic mucosa in Barrett's esophagus (BE). Its potential in reversing neoplastic lesions in squamous epithelium has been gradually explored. This article is aimed at reviewing the current evidence regarding the use of RFA on esophageal squamous cell neoplasia.
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Ke Y, van Munster S, Xue L, He S, Zhang Y, Dou L, Liu Y, Liu X, Liu Y, Li W, Lv N, Dawsey SM, Weusten BL, Bergman JJ, Wang G. Prospective study of endoscopic focal cryoballoon ablation for esophageal squamous cell neoplasia in China. Gastrointest Endosc 2019; 90:204-212. [PMID: 30922862 PMCID: PMC7545726 DOI: 10.1016/j.gie.2019.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 03/03/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Esophageal squamous cell neoplasia (ESCN) has a significant risk for progression to cancer. Current treatment options, endoscopic mucosal resection (EMR) or submucosal dissection (ESD), have their limitations. The cryoballoon focal ablation system (CbFAS) is a novel endoscopic ablation therapy device. We aimed to assess the safety, tolerability, and efficacy of CbFAS for eradication of ESCN. METHODS In this single-center prospective trial in China, patients with 1 flat unstained lesion (USL) on Lugol chromoendoscopy that contained moderate- or high-grade intraepithelial neoplasia (MGIN or HGIN, respectively) were enrolled. CbFAS was performed using side-by-side applications of 10 seconds, treatment was repeated at 3-month intervals until a complete response (CR) was established. The response at 12 months was the primary trial endpoint. Safety phone calls were performed at 2, 7, and 30 days after the initial CbFAS. RESULTS We enrolled 80 patients (59 MGIN, 21 HGIN) with a median USL length of 3 cm (interquartile range [IQR], 3-4). Seventy-nine received treatment, with a median of 5 side-by-side applications (IQR, 4-7) per patient over a median of 8 minutes (IQR, 5-10). After a single treatment, 70 of 78 patients (90%) exhibited CR, and 1 was lost to follow-up. The other 8 with persisting USLs were retreated, and all achieved CR after this second treatment. At 12 months after the initial CbFAS, 76 of 78 patients (97%) exhibited CR and 2 (3%) had recurrent MGIN. No strictures or serious adverse events occurred. Four patients developed self-limiting mucosal lacerations on balloon inflation. The postprocedure median pain score was 1 of 10 (IQR, 0-2) at day 2 and 0 (0-0) at days 7 and 30. CONCLUSIONS The results suggest that the CbFAS is safe, well tolerated, and effective in inducing endoscopic and histologic remission in patients with ESCN of limited size. (Clinical trial registration number: NCT02605759.).
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Affiliation(s)
- Yan Ke
- Department of endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - S.N. van Munster
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, the Netherlands,Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - Liyan Xue
- Department of Pathology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - Shun He
- Department of endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - Yueming Zhang
- Department of endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - Lizhou Dou
- Department of endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - Yong Liu
- Department of endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - Xudong Liu
- Department of endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - Yumeng Liu
- Department of endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - Wei Li
- Department of endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - Ning Lv
- Department of Pathology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - Sanford M. Dawsey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Bas L.A.M. Weusten
- Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, the Netherlands,Department of Gastroenterology and Hepatology, Academic Medical Centre Utrecht, Utrecht University, the Netherlands
| | - Jacques J.G.H.M. Bergman
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Guiqi Wang
- Department of endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
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Yu X, van Munster SN, Zhang Y, Xue L, Fleischer DE, Weusten BLAM, Lu N, Dawsey SSM, Bergman JJGHM, Wang G. Durability of radiofrequency ablation for treatment of esophageal squamous cell neoplasia: 5-year follow-up of a treated cohort in China. Gastrointest Endosc 2019; 89:736-748.e2. [PMID: 30905354 PMCID: PMC7517876 DOI: 10.1016/j.gie.2018.10.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/19/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Radiofrequency ablation (RFA) is an accepted treatment for flat Barrett's neoplasia. Less is known about RFA for esophageal squamous cell neoplasia (ESCN). Our group has reported several prospective studies of RFA for ESCN in China with promising results through 12 months of follow-up. In this cohort study we aimed to evaluate longer term outcomes after RFA for ESCN. METHODS Patients with flat unstained lesions (USLs) on Lugol's endoscopy containing moderate-/high-grade intraepithelial neoplasia (MGIN/HGIN) or mucosal cancer were treated with RFA every 3 months until complete remission (CR; no MGIN or a worse histologic grade). Patients with CR at 12 months (CR12) were included for follow-up and underwent annual Lugol's endoscopy with biopsy sampling and re-RFA for flat USLs. The clinical course of patients with persistent ESCN at 12 months (treatment failures) is also reported. RESULTS Among the 78 patients in CR12, 67 (86%) had sustained CR during a median of 48 months (interquartile range, 48-48) of follow-up and 5 endoscopies (interquartile range, 4-6). Recurrence occurred in 7 of 78 patients (9%; MGIN, n = 6; HGIN, n = 1); all lesions were managed with RFA. Four other patients (5%) had progression (to HGIN, n = 1; submucosal esophageal squamous cell carcinoma, n = 3). During follow-up protocol violations occurred in 46 of 78 patients (59%). Of the 12 treatment failures, progression occurred in 6. Overall, 2 patients developed subepithelial disease that was not visible after Lugol's endoscopy. Based on post-hoc analysis, the pink-color sign at baseline (a pink color change after Lugol's endoscopy) significantly predicted failure after RFA. CONCLUSIONS RFA is relatively easy to apply and can efficiently treat large areas with ESCN. Despite protocol violations that may have interfered with the efficacy of RFA in 59% of patients, most patients with CR12 had sustained CR during follow-up. However, some patients progressed to advanced disease and 2 developed subepithelial disease, not visible after Lugol's endoscopy. Based on currently available data, we advise the restriction of the use of RFA for flat MGIN and HGIN without the pink-color sign on Lugol's chromoendoscopy. (Clinical trial registration number: NCT02047305.).
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Affiliation(s)
- Xinying Yu
- Department of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Sanne N van Munster
- Department of Gastroenterology & Hepatology, Academic Medical Center, Amsterdam, the Netherlands
| | - Yueming Zhang
- Department of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Liyan Xue
- Department of Pathology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - David E Fleischer
- Department of Gastroenterology & Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Bas L A M Weusten
- Department of Gastroenterology & Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands; Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ning Lu
- Department of Pathology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Sanford S M Dawsey
- Department of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Jacques J G H M Bergman
- Department of Gastroenterology & Hepatology, Academic Medical Center, Amsterdam, the Netherlands
| | - Guiqi Wang
- Department of Endoscopy, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Canto MI, Abrams JA, Künzli HT, Weusten B, Komatsu Y, Jobe BA, Lightdale CJ. Nitrous oxide cryotherapy for treatment of esophageal squamous cell neoplasia: initial multicenter international experience with a novel portable cryoballoon ablation system (with video). Gastrointest Endosc 2018; 87:574-581. [PMID: 28720474 DOI: 10.1016/j.gie.2017.07.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 07/10/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Early esophageal squamous cell neoplasia (ESCN) can be successfully treated by EMR, endoscopic submucosal dissection (ESD), or radiofrequency ablation. A new portable, battery-powered cryotherapy system using nitrous oxide (cryoballoon focal ablation system [CbFAS]) has been used for Barrett's esophagus. It consists of a small hand-held device containing liquid nitrous oxide, which converts to gas within a low-pressure-compliant through-the-scope balloon and freezes targeted mucosa in contact with the balloon. This study evaluated the feasibility of endoscopic eradication of early ESCN with the CbFAS. METHODS Patients with early ESCN (defined as low-grade intraepithelial neoplasia [LGIN], high-grade intraepithelial neoplasia [HGIN], or early T1 squamous mucosal cancer) were treated with the CbFAS. After chromoendoscopy, all Lugol's unstained lesions (USLs) were targeted with 8, 10, or 12 seconds of ice per site, and treatment was repeated until biopsy samples demonstrated eradication of ESCN. Postprocedure adverse events were recorded. RESULTS Ten patients (4 men; median age, 69.5 years) with LGIN (n=2), HGIN (n=7), or esophageal squamous cell carcinoma (ESCC; n=1, after EMR) in 24 USLs were treated. The median maximum diameter of the largest USL was 1.5 cm (interquartile range, 1-2 cm), and median total length of all neoplastic USLs was 2 cm (range, 1-10 cm). Patients with focal disease received a median of 2 cryoablations, whereas 4 patients with large and/or multifocal circumferential neoplasia had 6 to 12 ablations per procedure. The median procedure time was 34 minutes (range, 18-57 minutes). Treatment was completed in all patients. No major adverse events occurred. Four patients developed mild self-limited chest pain requiring narcotic analgesics immediately after the procedure. Two patients who received circumferential ablation developed a stricture responding to dilation, with no recurrence. Complete endoscopic and pathologic response was achieved in all patients at 3 months. One year follow-up biopsy specimens in 7 patients showed no USL or ESCN. All patients were disease free at last visit, with a median follow-up time of 10.7 months (interquartile range, 4-14 months). CONCLUSIONS We report the first application of nitrous cryoballoon ablation for curative treatment of early primary or recurrent ESCN. Our initial experience suggests that efficacy is high and the safety profile is reasonable. Prospective trials are needed to optimize cryogen dosimetry and assess safety and efficacy.
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Affiliation(s)
- Marcia Irene Canto
- Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Julian A Abrams
- Digestive and Liver Disease, Columbia University Medical Center, New York, New York, USA
| | - Hannah T Künzli
- Gastroenterology and Hepatology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Bas Weusten
- Gastroenterology and Hepatology, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Yoshihiro Komatsu
- Department of Surgery, Alleghany Health Network, Pittsburgh, Pennsylvania, USA
| | - Blair A Jobe
- Department of Surgery, Alleghany Health Network, Pittsburgh, Pennsylvania, USA
| | - Charles J Lightdale
- Digestive and Liver Disease, Columbia University Medical Center, New York, New York, USA
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Raghu Subramanian C, Triadafilopoulos G. Diagnosis and therapy of esophageal squamous cell dysplasia and early esophageal squamous cell cancer. Gastroenterol Rep (Oxf) 2017. [DOI: 10.1093/gastro/gox022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Becq A, Camus M, Rahmi G, de Parades V, Marteau P, Dray X. Emerging indications of endoscopic radiofrequency ablation. United European Gastroenterol J 2015; 3:313-24. [PMID: 26279839 DOI: 10.1177/2050640615571159] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 01/12/2015] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Radiofrequency ablation (RFA) is a well-validated treatment of dysplastic Barrett's esophagus. Other indications of endoscopic RFA are under evaluation. RESULTS Four prospective studies (total 69 patients) have shown that RFA achieved complete remission of early esophageal squamous intra-epithelial neoplasia at a rate of 80%, but with a substantial risk of stricture. In the setting of gastric antral vascular ectasia, two prospective monocenter studies, and a retrospective multicenter study, (total 51 patients), suggest that RFA is efficacious in terms of reducing transfusion dependency. In the setting of chronic hemorrhagic radiation proctopathy, a prospective monocenter study and a retrospective multicenter study (total 56 patients) suggest that RFA is an efficient treatment. A retrospective comparative study (64 patients) suggests that RFA improves stents patency in malignant biliary strictures. CONCLUSIONS Endoscopic RFA is an upcoming treatment modality in early esophageal squamous intra-epithelial neoplasia, as well as in gastric, rectal, and biliary diseases.
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Affiliation(s)
- Aymeric Becq
- Department of Gastroenterology and Hepatology, Sorbonne Paris Cité Paris 7 University & APHP Lariboisière Hospital, Paris, France
| | - Marine Camus
- Department of Gastroenterology and Hepatology, Sorbonne Paris Cité Paris 7 University & APHP Lariboisière Hospital, Paris, France
| | - Gabriel Rahmi
- Department of Gastroenterology and Hepatology, Sorbonne Paris Cité Paris 5 University & APHP, European Georges Pompidou Hospital, Paris, France
| | - Vincent de Parades
- Department of Medicosurgical Proctology, Léopold Bellan Institute, Saint Joseph Hospital, Paris, France
| | - Philippe Marteau
- Department of Gastroenterology and Hepatology, Sorbonne Paris Cité Paris 7 University & APHP Lariboisière Hospital, Paris, France
| | - Xavier Dray
- Department of Gastroenterology and Hepatology, Sorbonne Paris Cité Paris 7 University & APHP Lariboisière Hospital, Paris, France
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Protano MA, Xu H, Wang G, Polydorides AD, Dawsey SM, Cui J, Xue L, Zhang F, Quang T, Pierce MC, Shin D, Schwarz RA, Bhutani MS, Lee M, Parikh N, Hur C, Xu W, Moshier E, Godbold J, Mitcham J, Hudson C, Richards-Kortum RR, Anandasabapathy S. Low-Cost High-Resolution Microendoscopy for the Detection of Esophageal Squamous Cell Neoplasia: An International Trial. Gastroenterology 2015; 149:321-329. [PMID: 25980753 PMCID: PMC4547689 DOI: 10.1053/j.gastro.2015.04.055] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 04/27/2015] [Accepted: 04/28/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS Esophageal squamous cell neoplasia has a high mortality rate as a result of late detection. In high-risk regions such as China, screening is performed by Lugol's chromoendoscopy (LCE). LCE has low specificity, resulting in unnecessary tissue biopsy with a subsequent increase in procedure cost and risk. The purpose of this study was to evaluate the accuracy of a novel, low-cost, high-resolution microendoscope (HRME) as an adjunct to LCE. METHODS In this prospective trial, 147 consecutive high-risk patients were enrolled from 2 US and 2 Chinese tertiary centers. Three expert and 4 novice endoscopists performed white-light endoscopy followed by LCE and HRME. All optical images were compared with the gold standard of histopathology. RESULTS By using a per-biopsy analysis, the sensitivity of LCE vs LCE + HRME was 96% vs 91% (P = .0832), specificity was 48% vs 88% (P < .001), positive predictive value was 22% vs 45% (P < .0001), negative predictive value was 98% vs 98% (P = .3551), and overall accuracy was 57% vs 90% (P < .001), respectively. By using a per-patient analysis, the sensitivity of LCE vs LCE + HRME was 100% vs 95% (P = .16), specificity was 29% vs 79% (P < .001), positive predictive value was 32% vs 60%, 100% vs 98%, and accuracy was 47% vs 83% (P < .001). With the use of HRME, 136 biopsies (60%; 95% confidence interval, 53%-66%) could have been spared, and 55 patients (48%; 95% confidence interval, 38%-57%) could have been spared any biopsy. CONCLUSIONS In this trial, HRME improved the accuracy of LCE for esophageal squamous cell neoplasia screening and surveillance. HRME may be a cost-effective optical biopsy adjunct to LCE, potentially reducing unnecessary biopsies and facilitating real-time decision making in globally underserved regions. ClinicalTrials.gov, NCT 01384708.
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Affiliation(s)
| | - Hong Xu
- Department of Endoscopy, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Guiqi Wang
- Department of Endoscopy, Cancer Institute and Hospital, The Chinese Academy of Medical Sciences, Beijing, China
| | | | - Sanford M. Dawsey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Junsheng Cui
- Department of Pathology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Liyan Xue
- Department of Pathology, Cancer Institute and Hospital, The Chinese Academy of Medical Sciences, Beijing, China
| | - Fan Zhang
- Department of Endoscopy, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Timothy Quang
- Department of Bioengineering, Rice University, Houston, TX
| | - Mark C. Pierce
- Biomedical Engineering, Rutgers University, Piscataway, NJ
| | - Dongsuk Shin
- Department of Bioengineering, Rice University, Houston, TX
| | | | - Manoop S. Bhutani
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michelle Lee
- Division of Gastroenterology, The Mount Sinai Medical Center, New York, NY
| | - Neil Parikh
- Division of Digestive Diseases, Yale University, New Haven, CT
| | - Chin Hur
- GI Unit & Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Weiran Xu
- Department of Endoscopy, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Erin Moshier
- Department of Preventative Medicine, The Mount Sinai Medical Center, New York, NY
| | - James Godbold
- Department of Preventative Medicine, The Mount Sinai Medical Center, New York, NY
| | - Josephine Mitcham
- Division of Gastroenterology, The Mount Sinai Medical Center, New York, NY
| | - Courtney Hudson
- Division of Gastroenterology, The Mount Sinai Medical Center, New York, NY
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Akiyama J, Komanduri S, Konda VJA, Mashimo H, Noria S, Triadafilopoulos G. Endoscopy for diagnosis and treatment in esophageal cancers: high-technology assessment. Ann N Y Acad Sci 2015; 1325:77-88. [PMID: 25266017 DOI: 10.1111/nyas.12526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The following, from the 12th OESO World Conference: Cancers of the Esophagus, includes commentaries on the endoscopic tools to recognize squamous cell dysplasia; confocal laser endomicroscopy for Barrett's esophagus; confocal microscopy in the cancer patient; optical coherence tomography in the assessment of subsquamous Barrett's metaplasia; endoscopic mucosal resection for high-grade dysplasia in Barrett's esophagus; HALO in the treatment of squamous dysplasia; and the use of fluorescence in situ hybridization to detect dysplasia and adenocarcinoma in patients with Barrett's esophagus.
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Affiliation(s)
- Junichi Akiyama
- National Center for Global Health and Medicine, Tokyo, Japan
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Repici A, Genco C, Anderloni A, Spaggiari P, Mineri R, Minieri R, Carlino A, Jovani M, Villanacci V, Sharma P, Malesci A. A case of esophageal squamous cell intraepithelial neoplasia with positivity for type 16 human papillomavirus successfully treated with radiofrequency ablation. J Gastrointest Oncol 2014; 5:E36-9. [PMID: 24772344 DOI: 10.3978/j.issn.2078-6891.2014.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 03/04/2014] [Indexed: 02/01/2023] Open
Abstract
Esophageal cancer is the eight most common cancer worldwide and the sixth cause of cancer related death with squamous cell carcinoma (SCC) accounting for almost half of all esophageal cancers. Persistent human papilloma virus (HPV) infection has been suspected to play an active role in esophageal carcinogenesis but a clear association has not still been proven and no specific indications or guidelines for possible endoscopic and surgical therapeutic approaches to this clinical scenario are available. We report a case of a 62-year-old woman with histological diagnosis of high-grade intraepithelial squamous neoplasia of distal esophagus associated with cytological modifications resembling cervical HPV infection and with a positive INNO-LiPA assay for genotype 16 HPV. A single session of radiofrequency ablation (RFA) was performed on the dysplastic esophageal area with complete endoscopic eradication as confirmed by the following endoscopic, histologic and microbiologic examinations. Our report might give further strength to the hypothesis of an etiological role of HPV in selected cases of esophageal carcinogenesis and opens a discussion on the possible use of Radio Frequency Ablation as an effective and safe endoscopic treatment for both early squamous cell neoplasia and HPV esophageal colonization.
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Affiliation(s)
- Alessandro Repici
- 1 Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Milan, Italy ; 2 Department of Gastroenterology, DIBIMIS, University of Palermo, Palermo, Italy ; 3 Department of Pathology, IRCCS Istituto Clinico Humanitas, Milan, Italy ; 4 Department of Laboratory Diagnostics, Pathology Section, Brescia, Italy ; 5 Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA
| | - Chiara Genco
- 1 Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Milan, Italy ; 2 Department of Gastroenterology, DIBIMIS, University of Palermo, Palermo, Italy ; 3 Department of Pathology, IRCCS Istituto Clinico Humanitas, Milan, Italy ; 4 Department of Laboratory Diagnostics, Pathology Section, Brescia, Italy ; 5 Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA
| | - Andrea Anderloni
- 1 Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Milan, Italy ; 2 Department of Gastroenterology, DIBIMIS, University of Palermo, Palermo, Italy ; 3 Department of Pathology, IRCCS Istituto Clinico Humanitas, Milan, Italy ; 4 Department of Laboratory Diagnostics, Pathology Section, Brescia, Italy ; 5 Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA
| | - Paola Spaggiari
- 1 Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Milan, Italy ; 2 Department of Gastroenterology, DIBIMIS, University of Palermo, Palermo, Italy ; 3 Department of Pathology, IRCCS Istituto Clinico Humanitas, Milan, Italy ; 4 Department of Laboratory Diagnostics, Pathology Section, Brescia, Italy ; 5 Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA
| | - Rossana Mineri
- 1 Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Milan, Italy ; 2 Department of Gastroenterology, DIBIMIS, University of Palermo, Palermo, Italy ; 3 Department of Pathology, IRCCS Istituto Clinico Humanitas, Milan, Italy ; 4 Department of Laboratory Diagnostics, Pathology Section, Brescia, Italy ; 5 Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA
| | | | - Alessandra Carlino
- 1 Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Milan, Italy ; 2 Department of Gastroenterology, DIBIMIS, University of Palermo, Palermo, Italy ; 3 Department of Pathology, IRCCS Istituto Clinico Humanitas, Milan, Italy ; 4 Department of Laboratory Diagnostics, Pathology Section, Brescia, Italy ; 5 Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA
| | - Manol Jovani
- 1 Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Milan, Italy ; 2 Department of Gastroenterology, DIBIMIS, University of Palermo, Palermo, Italy ; 3 Department of Pathology, IRCCS Istituto Clinico Humanitas, Milan, Italy ; 4 Department of Laboratory Diagnostics, Pathology Section, Brescia, Italy ; 5 Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA
| | - Vincenzo Villanacci
- 1 Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Milan, Italy ; 2 Department of Gastroenterology, DIBIMIS, University of Palermo, Palermo, Italy ; 3 Department of Pathology, IRCCS Istituto Clinico Humanitas, Milan, Italy ; 4 Department of Laboratory Diagnostics, Pathology Section, Brescia, Italy ; 5 Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA
| | - Prateek Sharma
- 1 Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Milan, Italy ; 2 Department of Gastroenterology, DIBIMIS, University of Palermo, Palermo, Italy ; 3 Department of Pathology, IRCCS Istituto Clinico Humanitas, Milan, Italy ; 4 Department of Laboratory Diagnostics, Pathology Section, Brescia, Italy ; 5 Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA
| | - Alberto Malesci
- 1 Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Milan, Italy ; 2 Department of Gastroenterology, DIBIMIS, University of Palermo, Palermo, Italy ; 3 Department of Pathology, IRCCS Istituto Clinico Humanitas, Milan, Italy ; 4 Department of Laboratory Diagnostics, Pathology Section, Brescia, Italy ; 5 Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA
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Radiofrequency ablation for the treatment of gastric dysplasia: a pilot experience in three patients. Eur J Gastroenterol Hepatol 2013; 25:863-8. [PMID: 23510961 DOI: 10.1097/meg.0b013e32835f8fa5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Different endoscopic techniques such as endoscopic mucosal resection, endoscopic submucosal dissection, argon-plasma coagulation, and photodynamic therapy have been used in the treatment of gastric dysplasia. Radiofrequency ablation (RFA) has become a recognized tool in the treatment of dysplastic Barrett's esophagus, but its use in gastric dysplasia has not yet been studied. We aim to describe three cases of RFA treatment in patients with persistent dysplastic gastric mucosa confirmed by consensus of two expert gastrointestinal pathologists. In each patient, two catheter-based RFA procedures were performed 8 weeks apart in an outpatient setting. Although each patient reported minor epigastric pain after RFA, there were no major complications such as bleeding, perforation, stricture, or the need for hospitalization. Endoscopic follow-up with extensive biopsy sampling 2, 4, 6, 12, and 18 months after the last RFA revealed negative results for dysplasia in all patients. These results suggest that RFA may be considered in the treatment of gastric dysplasia. The confirmation of these data with a large series can lead to a change in the paradigm of gastric dysplasia management.
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Abrams JA. Ablation of esophageal squamous neoplasia: addressing the bigger picture. Gastrointest Endosc 2011; 74:1191-3. [PMID: 22136771 DOI: 10.1016/j.gie.2011.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 07/05/2011] [Indexed: 12/11/2022]
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