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.

AIMTo identify the clinicopathological characteristics of pT1N0 esophageal squamous cell carcinoma (ESCC) that are associated with tumor recurrence.METHODSWe reviewed 216 pT1N0 thoracic ESCC cases who underwent esophagectomy and thoracoabdominal two-field lymphadenectomy without preoperative chemoradiotherapy. After excluding those cases with clinical follow-up recorded fewer than 3 mo and those who died within 3 mo of surgery, we included 199 cases in the current analysis. Overall survival and recurrence-free survival were assessed by the Kaplan-Meier method, and clinicopathological characteristics associated with any recurrence or distant recurrence were evaluated using univariate and multivariate Cox proportional hazards models. Early recurrence (≤ 24 mo) and correlated parameters were assessed using univariate and multivariate logistic regression models.RESULTSForty-seven (24%) patients had a recurrence at 3 to 178 (median, 33) mo. The 5-year recurrence-free survival rate was 80.7%. None of 13 asymptomatic cases had a recurrence. Preoperative clinical symptoms, upper thoracic location, ulcerative or intraluminal mass macroscopic tumor type, tumor invasion depth level, basaloid histology, angiolymphatic invasion, tumor thickness, submucosal invasion thickness, diameter of the largest single tongue of invasion, and complete negative aberrant p53 expression were significantly related to tumor recurrence and/or recurrence-free survival. Upper thoracic tumor location, angiolymphatic invasion, and submucosal invasion thickness were independent predictors of tumor recurrence (Hazard ratios = 3.26, 3.42, and 2.06, P < 0.001, P < 0.001, and P = 0.002, respectively), and a nomogram for predicting recurrence-free survival with these three predictors was constructed. Upper thoracic tumor location and angiolymphatic invasion were independent predictors of distant recurrence. Upper thoracic tumor location, angiolymphatic invasion, submucosal invasion thickness, and diameter of the largest single tongue of invasion were independent predictors of early recurrence.CONCLUSIONThese results should be useful for designing optimal individual follow-up and therapy for patients with T1N0 ESCC.

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 and study aims Endoscopic resection for esophageal squamous high-grade intraepithelial neoplasia (HGIN) or intramucosal cancer (esophageal squamous cell carcinoma [ESCC]) with the endoscopic resection cap technique is technically difficult, and requires submucosal lifting and multiple snares for piecemeal resections. Multiband mucosectomy (MBM) is an easy-to-use endoscopic resection technique and may be the modality of choice in China, where ESCC is extremely prevalent. The aim of the current study was to prospectively evaluate MBM for piecemeal endoscopic resection of squamous neoplasia of the esophagus. Methods Patients with HGIN/ESCC and no signs of submucosal invasion or metastatic disease were included in the study. Lesions were delineated using electrocoagulation and resected using the MBM technique. Endpoints were procedure time, endoscopic radicality, complications, histology of the endoscopic resection specimens, and absence of HGIN/ESCC at the endoscopic resection scar during follow-up. Results a total of 41 patients (26 male; mean age 61 years) underwent MBM; all lesions were visible with white light endoscopy (median length 5 cm, interquartile range [IQR] 4–6 cm; median circumferential extent 42%, IQR 25%–50%). Median procedure time was 12 minutes (IQR 8–24 minutes). Median number of resections was 5 (IQR 3–6). Endoscopic complete resection was achieved in all lesions. There was one perforation, which was treated by application of clips. No other complications were observed. The worst histology was ESCC (n = 19), HGIN (n = 17), middle grade intraepithelial neoplasia (n = 4), and normal squamous epithelium (n = 1). Endoscopic follow-up at 3 months showed HGIN at the endoscopic resection scar in two patients, which was effectively treated endoscopically, and showed normal squamous epithelium in all patients at final follow-up (median 15 months, IQR 12–24 months). Conclusion This first prospective study on MBM for piecemeal endoscopic resection of early esophageal squamous neoplasia showed that MBM was effective for the complete removal of lesions with short procedure time, few complications, effective histological assessment of resected specimens, and durable treatment effect.

BackgroundEndoscopic treatments for early esophageal squamous cell carcinoma and the esophageal neoplasm are two types: endoscopic resection (ER) and ablation. Resection enables evaluation of the lesion in the ER specimens, while ablation cannot. We sought to establish a pre-ER evaluated system with a diagnostic and staging accuracy similar to ER for the development of ablation therapy.MethodsIn our study, we collected data pertaining to early esophageal cancer and esophageal neoplasm treated with ER, analyzed the pre- and post-ER data of the lesions and evaluated the diagnostic accuracy of pre-ER system compared with the gold standard.ResultsThe diagnostic accuracy rate was 91% based on the pre-ER system compared with the gold standard, and 93% based on the ER diagnosis. The AUC of the pre-ER system was 0.964, while the ER examination was 0.971.ConclusionThese results suggest that the accuracy of pre-ER system was comparable to ER. The pre-ER system enables prediction of histological diagnosis and stage of the lesions, and the choice of treatment for superficial esophageal neoplasm.

Background Lymphovascular invasion (LVI) is a crucial predictor of lymph node metastasis (LNM). However, few studies have investigated the LVI positivity rate and its clinical significance in pT1b esophageal squamous cell carcinoma (ESCC) using immunohistochemistry and elastin staining. Methods We collected data from158 patients with pT1b ESCC who had undergone radical esophagectomy. All paraffin blocks of invasive carcinoma from each patient were subjected to HE staining, elastin staining + CK (AE1/AE3) immunohistochemistry (E&IHC), and CD31/D2-40 + CK (AE1/AE3) double immunohistochemistry (D-IHC). The LVI was classified into types, i.e., vascular invasion (VI) and lymphatic vessel invasion (LI), and its location, quantity, and clinical significance were explored. Results The positivity rates of VI by E&IHC (E-VI), VI by CD31D-IHC (CD31-VI), and LI by D2-40 D-IHC (D2-40-LI) were significantly higher than those obtained by HE staining (P < 0.001, respectively). CD31-VI and E-VI were independent adverse prognostic factors for recurrence-free survival (RFS), and they were significantly associated with poor distant metastasis-free survival and overall survival in pT1b ESCC. Intratumoral LVI was also crucial in pT1b ESCC, and L2 (the count of D2-40-LI was 5 or more) was the strongest predictor for LNM and RFS in pT1b ESCC. Conclusion E&IHC and D-IHC can dramatically improve the detection rate of LVI in pT1b ESCC, and the classification and grading of LVI can help to improve the prediction of LNM and prognosis.

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