Predictors for postoperative esophageal stricture after balloon-based radiofrequency ablation for early esophageal squamous neoplasia: A multicenter validation study
Journal
Therapeutic Advances in Gastroenterology
Journal Volume
9
Journal Issue
3
Pages
257-264
Date Issued
2016
Author(s)
Wang W.-L.
Chang I.-W.
Chang W.-L.
Chu Y.-Y.
Wu P.-H.
Tai W.-C.
Chen P.-Y.
Hsieh P.-H.
Chung C.-S.
Chang C.-Y.
Lin J.-T.
Lee C.-T.
Abstract
Background: Endoscopic radiofrequency ablation (RFA) is a rapidly evolving therapeutic modality for early flat esophageal squamous cell neoplasms (ESCNs), but the risk factors for postoperative stricture have not been elucidated. The objective of this study was to identify and validate a predictor for post-RFA stenosis. Methods: We consecutively enrolled patients with flat-type 'large' (length no less than 3 cm extending no less than half the circumference of the esophagus), early ESCNs, treated with balloon-based RFA (12 J/cm2-clean-12 J/cm2 regimen). The tumor and technical factors for postoperative stricture were investigated and we validated the results externally with a society-based multicenter cohort using the same ablation regimen. Results: A total of 51 patients were enrolled (30 in the development set and 21 in the validation set). The complete remission rate at 12 months was 93%, and the rates of perforation and postoperative stenosis were 0% and 17%, respectively. Patients with post-RFA stenosis had a significantly larger longitudinal tumor size (mean 115 versus 61 mm, p = 0.003). There were no significant differences in age, body mass index, tumor circumferential extension, pretreatment histological grade, treatment efficacy or size of balloon catheter between the groups with or without stenosis. The optimal cut-off value was set as 9 cm to predict post-RFA stenosis by receiver operating characteristic curve [area under curve (AUC) = 0.881], which was then confirmed to be a reliable predictor by multivariate analysis (odds ratio, 12.7, 95% confidence interval, 1.18-136.28, p = 0.03) and have a good predictive performance in the validation set (AUC = 0.876). Conclusions: The most frequent adverse event of RFA was esophageal stenosis, for which the longitudinal tumor size was a significant predictive factor. Early intervention or prevention for stricture should be applied for those with long segment (?3/49 cm) ESCNs. ? 2016 The Author(s).
SDGs
Other Subjects
adult; aged; Article; balloon based radiofrequency ablation; balloon dilatation; cancer regression; controlled clinical trial; controlled study; early cancer; esophageal hematoma; esophageal squamous cell carcinoma; esophagus stenosis; female; hematoma; human; human tissue; laceration; major clinical study; male; mucosal disease; mucosal laceration; multicenter study; priority journal; prospective study; radiofrequency ablation; receiver operating characteristic; risk factor; sensitivity and specificity; treatment response; tumor localization; tumor volume; validation study
Publisher
SAGE Publications Ltd
Type
journal article