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Comparison between ESD and RFA in patients with total or near-total circumferential early esophageal squamous cell neoplasia

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Abstract

Background

Patients with early esophageal squamous cell neoplasias (ESCNs) that are totally or nearly totally circumferential face challenges in their clinical work. Endoscopic submucosal dissection (ESD) frequently leads to esophageal strictures. Endoscopic radiofrequency ablation (RFA), which stands out for its simplicity of use and low rate of stenosis, is a rapidly evolving therapeutic strategy for early ESCNs. We contrast ESD with RFA in order to find which method is best for the treatment of a wide range of esophageal diseases.

Methods

Patients who had flat-type, early, large ESCNs (extending more than 3/4 of the esophageal circumference) treated endoscopically were enrolled retrospectively. The primary outcome measurements were adverse events and local control of the neoplastic lesion.

Results

A total of 105 patients received treatment; 60 had ESD and 45 received RFA. Despite the patients receiving RFA typically having larger tumors (14.27 vs. 5.70 cm, P < 0.05), the local control of the neoplastic lesion and procedure-related complications were comparable between the ESD and RFA groups. A considerably higher risk of esophageal stenosis was observed in patients with extensive lesions in the ESD group compared to the RFA group (60% vs. 31%; P < 0.05), and the rate of refractory stricture is also higher than that of the RFA.

Conclusion

Both RFA and ESD are effective in treating large, flat, early ESCNs; however, ESD is more likely to cause side effects, such as esophageal stricture, particularly in lesions that are larger than 3/4 of the diameter. Before RFA, a more precise and thorough pretreatment examination should be performed. A more accurate pretreatment evaluation will be an important development direction for early esophageal cancer in future. After surgery, a strict routine review is crucial.

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Author contributions

YD and YL contributed equally to this manuscript. YD contributed to study design, date collection, analysis and interpretation of data, drafting of the manuscript, and critical revision of manuscript for important intellectual content. YL contributed to study design, analysis and interpretation of data, and critical revision of the manuscript. SL has conducted a preliminary study, study design, analysis and interpretation of data, statistical analysis, and study supervision. WZ, QQ, and YZ contributed to data collection. RS contributed to study design, technical support, critical revision of the manuscript, fund collection, and study supervision, and revising the final manuscript. All authors have significantly contributed. All authors are in agreement with the content of the manuscript.

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Author notes

  1. Yuan Ding and Yang Liu have contributed equally.

Authors and Affiliations

  1. Medical School of Southeast University, Nanjing, 210009, China

    Yuan Ding, Yang Liu, Wanyue Zhang, Qiliu Qian, Yawen Zhao & Ruihua Shi

  2. Department of Gastroenterology, Southeast University Affiliated Zhongda Hospital, No. 87 Dingjiaqiao, Nanjing, 210009, China

    Yuan Ding, Yang Liu, Wanyue Zhang, Qiliu Qian, Yawen Zhao & Ruihua Shi

  3. Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China

    Siyu Lei

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  1. Yuan Ding
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Correspondence to Ruihua Shi.

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Disclosures

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Yuan Ding, Yang Liu, Siyu Lei, Wanyue Zhang, Qiliu Qian, Yawen Zhao, and Ruihua Shi have no conflicts of interest or financial ties to disclose.

Ethics approval and consent to participate

The protocol is in accordance with the ethical guidelines of the 1975 Declaration of Helsinki, as reflected by prior approval by one Chinese tertiary academic hospital (2020ZDSYLL259-P01) from Zhongda Hospital Southeast University. All participants will be informed that their anonymous data will be used for research and publication. Relevant information about this project will be provided to potential eligible participants in oral and written forms for them to make their own decisions about participation or not. Each participant will be informed that he or she can withdraw from the study at any time and that withdrawal will not affect his or her subsequent medical treatment.

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Ding, Y., Liu, Y., Lei, S. et al. Comparison between ESD and RFA in patients with total or near-total circumferential early esophageal squamous cell neoplasia. Surg Endosc 37, 6915–6921 (2023). https://doi.org/10.1007/s00464-023-10178-8

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  • DOI: https://doi.org/10.1007/s00464-023-10178-8

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