A case series on the use of circumferential radiofrequency ablation for early esophageal squamous neoplasias in patients with esophageal varices

Wen Lun Wang, I. Wei Chang, Chien Chuan Chen, Chi Yang Chang, Lein Ray Mo, Jaw Town Lin, Hsiu Po Wang, Ching Tai Lee

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background and Aims Endoscopic radiofrequency ablation (RFA) is a rapidly evolving therapeutic modality for early esophageal squamous cell neoplasias (ESCNs). However, the feasibility of RFA for ESCNs in the setting of esophageal varices has not been reported. Methods We retrospectively enrolled 8 consecutive patients with cirrhosis (Child-Pugh score ≤6) with early flat-type ESCNs (high-grade intraepithelial neoplasia/intramucosal cancer, and Lugol unstained lesion [USL] length ≥3 cm extending ≥1/2 the circumference) on or adjacent to esophageal varices, for which circumferential RFA was applied as the initial treatment. The primary endpoint was a complete response at 12 months, and the secondary endpoints were adverse events and procedure-related mortality. Results The mean USL length was 5.3 cm (range, 3–10 cm), and the average length of the treatment area was 7.5 cm (range, 5–12 cm), with an average procedure time of 31.9 min (range, 25–40 min). After circumferential RFA, 3 adverse events were recorded, including 2 intramucosal hematomas and 1 mucosal laceration, all of which spontaneously resolved without further management. No massive bleeding, perforation, stricture, or hepatic failure occurred after the procedure. Six of the 8 patients achieved a complete response after single circumferential RFA, but 2 had residual squamous neoplasias. After additional focal-type RFA treatment, all achieved a complete response at 12 months. No neoplastic progression or recurrence occurred during a median follow-up period of 21.6 months (range, 13–42 months). Conclusions RFA was associated with good treatment results, no neoplastic progression, and an acceptable adverse event profile for the treatment of early ESCNs in patients with well-compensated cirrhosis and esophageal varices.

Original languageEnglish
Pages (from-to)322-329
Number of pages8
JournalGastrointestinal Endoscopy
Volume85
Issue number2
DOIs
Publication statusPublished - Feb 1 2017
Externally publishedYes

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Esophageal and Gastric Varices
Epithelial Cells
Neoplasms
Fibrosis
Therapeutics
Lacerations
Liver Failure
Hematoma
Pathologic Constriction
Hemorrhage
Recurrence
Mortality

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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A case series on the use of circumferential radiofrequency ablation for early esophageal squamous neoplasias in patients with esophageal varices. / Wang, Wen Lun; Chang, I. Wei; Chen, Chien Chuan; Chang, Chi Yang; Mo, Lein Ray; Lin, Jaw Town; Wang, Hsiu Po; Lee, Ching Tai.

In: Gastrointestinal Endoscopy, Vol. 85, No. 2, 01.02.2017, p. 322-329.

Research output: Contribution to journalArticle

Wang, Wen Lun ; Chang, I. Wei ; Chen, Chien Chuan ; Chang, Chi Yang ; Mo, Lein Ray ; Lin, Jaw Town ; Wang, Hsiu Po ; Lee, Ching Tai. / A case series on the use of circumferential radiofrequency ablation for early esophageal squamous neoplasias in patients with esophageal varices. In: Gastrointestinal Endoscopy. 2017 ; Vol. 85, No. 2. pp. 322-329.
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AU - Lin, Jaw Town

AU - Wang, Hsiu Po

AU - Lee, Ching Tai

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AB - Background and Aims Endoscopic radiofrequency ablation (RFA) is a rapidly evolving therapeutic modality for early esophageal squamous cell neoplasias (ESCNs). However, the feasibility of RFA for ESCNs in the setting of esophageal varices has not been reported. Methods We retrospectively enrolled 8 consecutive patients with cirrhosis (Child-Pugh score ≤6) with early flat-type ESCNs (high-grade intraepithelial neoplasia/intramucosal cancer, and Lugol unstained lesion [USL] length ≥3 cm extending ≥1/2 the circumference) on or adjacent to esophageal varices, for which circumferential RFA was applied as the initial treatment. The primary endpoint was a complete response at 12 months, and the secondary endpoints were adverse events and procedure-related mortality. Results The mean USL length was 5.3 cm (range, 3–10 cm), and the average length of the treatment area was 7.5 cm (range, 5–12 cm), with an average procedure time of 31.9 min (range, 25–40 min). After circumferential RFA, 3 adverse events were recorded, including 2 intramucosal hematomas and 1 mucosal laceration, all of which spontaneously resolved without further management. No massive bleeding, perforation, stricture, or hepatic failure occurred after the procedure. Six of the 8 patients achieved a complete response after single circumferential RFA, but 2 had residual squamous neoplasias. After additional focal-type RFA treatment, all achieved a complete response at 12 months. No neoplastic progression or recurrence occurred during a median follow-up period of 21.6 months (range, 13–42 months). Conclusions RFA was associated with good treatment results, no neoplastic progression, and an acceptable adverse event profile for the treatment of early ESCNs in patients with well-compensated cirrhosis and esophageal varices.

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