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Background and study aims Endoscopic radiofrequency ablation (RFA) is an established therapy for Barrett’s esophagus. Preliminary reports, limited by low patient numbers, suggest a possible role for RFA for early esophageal squamous cell neoplasia (ESCN), as well. The aim of this study was to evaluate the safety and effectiveness of RFA for early ESCN [moderate-grade/high-grade intraepithelial neoplasia (MGIN/HGIN) and early flat-type esophageal squamous cell carcinoma (ESCC)]. Patients and methods In this prospective cohort study, patients had ≥1 flat (type 0-IIb) unstained lesion (USL) on Lugol’s chromoendoscopy and a consensus diagnosis of MGIN, HGIN, or early ESCC. RFA was used at baseline to treat all USLs, then biopsy (and focal RFA if USL(s) persisted) was performed every 3 months until all biopsies were negative for MGIN, HGIN and ESCC. The main outcome measurements were complete response (CR) at 3 and 12 months (absence of MGIN, HGIN, and ESCC), neoplastic progression, and adverse events. Results 96 patients participated (MGIN 45, HGIN 42, early ESCC 9). At 3 and 12 months, respectively, 73% (70/96) and 84% (81/96) were CR. Two patients (2%) progressed (MGIN to HGIN; HGIN to T1m2 ESCC); both were treated endoscopically and achieved CR. Stricture occurred in 20 patients (21%), all after circumferential RFA. Lugol’s + RFA 12 J/cm2 (single application, no cleaning) was the favored baseline circumferential RFA technique (82% 12-month CR, 6% stricture). Conclusion In patients with early ESCN, RFA is associated with a high CR rate and acceptable safety profile.

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Important evidence indicates that the microbiota plays a key role in esophageal squamous cell carcinoma (ESCC). Here, paired saliva and brush specimens were obtained from 276 participants undergoing upper gastrointestinal endoscopic examination before or during screening for upper gastrointestinal (UGI) cancer. The esophageal microbiota was investigated by 16S rRNA gene profiling and next-generation sequencing. We observed that as the disease progressed, the α diversity in the saliva and cell brush samples decreased. Linear discriminant analysis effect size (LEfSe) results showed that in both the saliva and cell brush specimens, Granulicatella, Rothia, Streptococcus, Gemella, Leptotrichia and Schaalia were common biomarkers in patients with low-grade dysplasia, Lactobacillus was a common biomarker in patients with high-grade dysplasia, and Bosea, Solobacterium, Gemella, and Peptostreptococcus were common biomarkers in patients with esophageal cancer. The top 3 genera in the saliva and cell brush specimens had areas under the curve (AUCs) of 87.16 and 89.13%, respectively, to distinguish ESCC patients from normal people. The PICRUSt2 results identified in brush samples that patients with ESCC had decreased nitrate reductase functions. Our results suggest that future studies can focus on the function of the characteristic bacteria in ESCC.

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Introduction Piecemeal endoscopic resection (ER) for esophageal high-grade intraepithelial neoplasia (HGIN) or early squamous cell carcinoma (ESCC) is usually performed with the ER-cap technique. This requires submucosal lifting and multiple snares. Multiband mucosectomy (MBM) uses a modified variceal-band ligator without submucosal lifting. In high-risk areas where ESCC is common and limited endoscopic expertise is available, MBM might be a better applicable ER-technique. Aim To compare MBM to ER-cap for piecemeal ER of esophageal ESCC. Methods Patients with mucosal HGIN/ESCC (≥2≤6 cm, max 2/3 of circumference) were included. Lesions were delineated after 1.25% Lugol staining, followed by randomisation to MBM or ER-cap and piecemeal resection. Endpoints: procedure-time, procedure-costs, complete endoscopic resection, adverse events, absence of HGIN/ESCC at 3 and 12 months follow-up. Results In 84 patients (59 male, mean age 60 yrs) ER was performed with MBM (n=42) or ER-cap (n=42). There was no difference in baseline characteristics. Endoscopic complete resection was achieved in all lesions. Procedure time was significantly shorter with MBM (11 vs. 22 minutes, p<0.0001). One perforation was seen after ER-cap and treated conservatively. Total costs of disposables was less for MBM (€200 vs. €251, p=0.04). At 3 and 12 months follow-up none of the patients demonstrated HGIN/ESCC at the resection site. Conclusion Piecemeal ER of esophageal ESCC with MBM is faster and cheaper compared to ER-cap. Both techniques are highly effective and safe. MBM may have significant advantages over the ER-cap technique, especially in countries where ESCC is extremely common but endoscopic expertise and resources are limited.

Background: To explore the effects of smoking and drinking on the microbiota in the saliva and three segments of the esophagus (upper, middle, and lower) in healthy individuals.Methods: Paired saliva and brush specimens were obtained from 76 participants who underwent upper gastrointestinal (UGI) endoscopic examination for UGI cancer screening. The esophageal microbiota was investigated by 16S rRNA gene profiling via next-generation sequencing.Results: The saliva samples from non-smoking and non-drinking participants had a greater abundance of Neisseria, Prevotella, Porphyromonas, and Rothia, and lower levels of Streptococcus, Actinobacillus, and Haemophilus compared to the esophagus. There were no significant differences in the abundance of most bacterial genera in the upper, middle, and lower oesophagus. Similarly, in the saliva of patients who smoke and drink, there was a higher prevalence of Neisseria, Prevotella, Porphyromonas, Fusobacterium, and Rothia, and a lower prevalence of Streptococcus, Actinobacillus, and Haemophilus compared to the esophagus. There were no significant differences in the abundance of most genera in the upper, middle, and lower esophagus of patients with a history of drinking and smoking. There were slight differences in the microbiota between smoking and drinking individuals and non-smoking and non-drinking individuals.Conclusions: This pilot study demonstrated microbial diversity at different taxonomic levels in the oral cavity and esophagus of non-drinking and non-smoking individuals, as well as healthy people who drink and smoke . There was a slight difference in the microbiota between non-drinking and non-smoking people and individuals with a history of drinking and smoking. These results suggested that oral or esophageal cancer caused by smoking and drinking may not be mediated by mechanisms that affect surface microorganisms.

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