RFA to Prevent Metachronous Squamous Neoplasia Recurrence After Complete Endoscopic Submucosal Dissection
Status:
Recruiting
Trial end date:
2026-12-30
Target enrollment:
Participant gender:
Summary
Esophageal cancer is a highly lethal disease, and its incidence is still increasing in the
world. Recent advances in image-enhanced techniques such as Lugol chromoendoscopy and narrow
band imaging, the number of patients with early esophageal squamous cell neoplasias (ESCNs)
detected has markedly increased. Endoscopic submucosal dissection (ESD) enables en bloc
resection of the neoplasia, and the resected specimen allows for a pathological assessment to
evaluate the curability. However, the patients who received complete ESD for early ESCNs
frequently developed metachronous recurrence. The cumulative metachronous recurrence rate at
5 years was 50%, and the mean annual incidence of newly diagnosed metachronous tumors was
10%. Among them, those with "speckled" lugol staining pattern over the esophageal background
mucosa have the highest risk and should be seen as a precancerous lesion of ESCCs. This issue
is gaining attention in the era of endoscopic treatment, but currently there was no
appropriate strategy to prevent the tumor recurrence in these high-risk subjects.
Endoscopic radiofrequency ablation (RFA) is a rapidly evolving therapeutic modality, and
recent studies have shown its efficacy and safety for eradicating for flat type early ESCNs.
To search a best strategy for the prevention of ESCNs, the investigators thus propose a
hypothesis that the preemptive RFA for esophageal "speckled" lugol background mucosa may
prevent the metachronous neoplastic recurrence after complete endoscopic resection.