The in vivo tissue effect of endoscopic balloon-based radiofrequency ablation in treating esophageal squamous cell neoplasia

Wen Lun Wang, I. Wei Chang, Chien Chuan Chen, Chi Yang Chang, Cheng Hao Tseng, Chi Ming Tai, Jaw Town Lin, Hsiu Po Wang, Ching Tai Lee

Research output: Contribution to journalArticle

Abstract

Background: Endoscopic radiofrequency ablation (RFA) is a rapidly evolving therapeutic modality for early flat esophageal squamous cell neoplasms (ESCNs). However, the in vivo tissue effects of RFA on the esophageal wall are uncertain. Methods: We prospectively enrolled eight patients with flat-type early ESCNs who were treated with balloon-based RFA. We evaluated the in vivo tissue effect on the esophagus using endoscopic ultrasound (EUS) and the histology of retrieved coagulum. Results: The mean tumor length was 6.1 cm, and six of the eight patients achieved a complete response after primary RFA. Real-time evaluation of the tissue effect showed that the mucosa and submucosal layer were more edematous and thicker after RFA than before the procedure (mean 4.89 vs. 2.04 mm, p<.001), suggesting that the thermal effect of RFA may injure the submucosa. Histological evaluation of retrieved coagulum showed a severe cauterization (burning) effect with extensive cell necrosis; however, four cases had some residual viable neoplastic cells. Even though there were viable cells in the sloughed coagulum, half of the patients still achieved complete remission after RFA. Conclusions: Our findings suggest that the thermal effect of RFA may injure the submucosal layer and enable neoplastic epithelium to slough off without “burning.”.

Original languageEnglish
Pages (from-to)656-661
Number of pages6
JournalUnited European Gastroenterology Journal
Volume6
Issue number5
DOIs
Publication statusPublished - Jun 1 2018
Externally publishedYes

Keywords

  • adverse event
  • endoscopic ultrasound
  • esophageal squamous cell neoplasia
  • Radiofrequency ablation
  • stricture
  • tissue effect

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology

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