Endoscopic background mucosal resurfacing to prevent metachronous recurrence of superficial esophageal squamous cell cancer after curative endoscopic submucosal dissection: randomized pilot study with 5-year follow-up (with video) - 08/05/25
Abstract |
Background and Aims |
Metachronous recurrence frequently develops in patients with superficial esophageal squamous cell carcinomas (ESCCs) after curative endoscopic submucosal dissection (ESD), especially in those with multiple (>10) small Lugol-voiding lesions (LVLs) over the endoscopic background mucosa (ie, speckled pattern). We conducted a randomized controlled trial to investigate whether endoscopic radiofrequency ablation (RFA) for endoscopic background mucosal resurfacing (EBMR) can decrease the rate of metachronous neoplasia.
Methods |
Patients who received curative ESD and whose Lugol staining showed a speckled pattern over the background mucosa were randomly assigned in a 1:1 ratio to receive either RFA (EBMR group) or endoscopic surveillance alone (control group). EBMR with RFA was performed with a balloon device for circumferential ablation of the total esophageal mucosa 2 to 3 months after ESD. The primary outcome was the metachronous recurrence of squamous neoplasia during a 5-year follow-up period. Secondary outcomes were major adverse events.
Results |
Of 112 patients screened, 30 were randomized to receive EBMR (n = 15) or surveillance (n = 15). The mean procedure time of EBMR was 30.7 minutes (range, 25-40). One patient developed post-RFA stenosis, which resolved after 3 sessions of endoscopic dilation. EBMR reduced the risk of metachronous recurrence (0% in the EBMR group vs 53% in the control group, P = .001), with a number needed to treat of 1.9. Reversal of the Lugol-staining speckled pattern to only a few LVLs occurred in all patients and persisted for at least 5 years in the ablation group.
Conclusions |
In this randomized trial of patients with multiple small LVLs over the endoscopic background after curative ESD, EBMR with balloon-type RFA is a promising and safe procedure for preventing metachronous recurrence over 5 years of follow-up. (Clinical trial registration number: NCT03183115.)
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Abbreviations : ALDH2, EBMR, ESCC, ESD, LVL, RFA
Plan
| DIVERSITY, EQUITY, AND INCLUSION: We worked to ensure gender balance in the recruitment of human subjects. We worked to ensure ethnic or other types of diversity in the recruitment of human subjects. We worked to ensure that the language of the study questionnaires reflected inclusion. While citing references scientifically relevant for this work, we actively worked to promote gender balance in our reference list. |
Vol 101 - N° 6
P. 1145-1154 - juin 2025 Retour au numéro
Article précédent
- Validation of British Society of Gastroenterology guidelines for acute lower GI bleeding from 8956 cases in Japan
- Ken Kinjo, Tomonori Aoki, Katsumasa Kobayashi, Atsushi Yamauchi, Atsuo Yamada, Jun Omori, Takashi Ikeya, Taiki Aoyama, Naoyuki Tominaga, Yoshinori Sato, Takaaki Kishino, Naoki Ishii, Tsunaki Sawada, Masaki Murata, Akinari Takao, Kazuhiro Mizukami, Shunji Fujimori, Takahiro Uotani, Minoru Fujita, Hiroki Sato, Sho Suzuki, Toshiaki Narasaka, Junnosuke Hayasaka, Tomohiro Funabiki, Yuzuru Kinjo, Akira Mizuki, Shu Kiyotoki, Tatsuya Mikami, Ryosuke Gushima, Hiroyuki Fujii, Yuta Fuyuno, Takuto Hikichi, Yosuke Toya, Kazuyuki Narimatsu, Noriaki Manabe, Koji Nagaike, Tetsu Kinjo, Yorinobu Sumida, Sadahiro Funakoshi, Kiyonori Kobayashi, Tamotsu Matsuhashi, Yuga Komaki, Kazuhiro Watanabe, Takashi Hisabe, Kenshi Yao, Mitsuru Kaise, Naoyoshi Nagata
- Interobserver agreement in dysplasia grading of intraductal papillary mucinous neoplasms: performance of Kyoto guidelines and optimization of endomicroscopy biomarkers through pathology reclassification
- Matthew Leupold, Wei Chen, Ashwini K. Esnakula, Wendy L. Frankel, Stacey Culp, Philip A. Hart, Ahmed Abdelbaki, Zarine K. Shah, Erica Park, Peter Lee, Mitchell L. Ramsey, Samuel Han, Hamza Shah, Jordan Burlen, Georgios I. Papachristou, Zobeida Cruz-Monserrate, Mary Dillhoff, Jordan M. Cloyd, Timothy M. Pawlik, Somashekar G. Krishna
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?