Safety and efficacy of endoscopic treatment with mucosal resection, radiofrequency ablation, and cryotherapy in the curative treatment of early esophageal squamous cell cancer and dysplasia.

Abstract

4055 Background: Endoscopic esophageal treatment (EET), by radiofrequency ablation (RFA), cryoablation (Cryo), and endoscopic mucosal resection (EMR) has not been extensively studied in early esophageal squamous cell carcinoma (SCC). Aim: To assess the safety and success of EET in curative treatment of early esophageal SCC: (T1a, T1b, T2) and squamous cell dysplasia (SCD). Methods: We retrospectively reviewed records of patients with SCC (T1a, T1b, T2) and SCD treated with EET from January 2010 to August 2024. All patients had at least one follow-up endoscopic biopsy after treatment. Results: 62 patients met the eligibility criteria. Table. 46 patients (74%) had T1a (n=36.5%) or T1b (n=10.1%) SCC. T2 patients (21%) received ETT for local recurrence after chemoradiation. The most frequent ETT was EMR + RFA, n= 26 (41.9%) and RFA, n=20 (32%). In the first biopsy after treatment, 46 of the 62 patients (74.1%) had no residual cancer. This number increased after further ETT. 2 years after treatment only 4 patients had persistent cancer. BMI is significantly associated with survival status. No patient had disease progression that required surgery. Strictures formed in 15 patients (24%) post- ETT. Conclusions: ETT provides curative treatment of early SSC in up to 94% of patients. Association between cancer persistence at first post-biopsy with various demographic and clinical variables. Patient Characteristics Total N=62 P-value Sex (%) Male 28 (45.16%) 0.49 Female 34 (54.84%) Race (%) White / Caucasian 52 (83.87%) 0.716 Hispanic 2 (3.23%) Black 2 (3.23%) Asian 4 (6.45%) BMI, median (range) N = 62 24.02 (15, 44.5) 0.045 Smoking Status (%) No 25 (40.32%) 0.182 Yes 37 (59.68%) Alcohol Drinking (%) No 22 (35.48%) >0.99 Yes 40 (64.52%) Squamous Dysplasia (%) none 59 (95.16%) >0.99 Low 1 (1.61%) High 2 (3.23%) Squamous tumor staging (%) none 3 (4.84%) 0.174 T1a 36 (58.06%) T1b 10 (16.13%) ≥T2 13 (20.97%) Squamous Tumor Differentiation (%) Well 5 (8.2%) 0.707 Moderate 47 (77.05%) Poor 9 (14.75%) Lymphovascular Invasion (%) No 57 (91.94%) >0.99 Yes 5 (8.06%) 1b) Patient survival status - Immediate Post-Treatment Pathology Finding Patient Characteristics Total N=62 First biopsy post-treatment finding (%) No dysplasia or cancer 37 (59.68%) Persistent cancer (Failure of t/t) 16 (25.81%) Persistent Dysplasia 9 (14.52%) 1c) Patient survival status ≥2 years post-treatment, excluding patients with no data or recurrent cancer/dysplasia Patient Characteristics Total N=21 Biopsy finding (%) No dysplasia or cancer 15 (71.43%) Persistent cancer (Failure of t/t) 4 (19.05%) Persistent Dysplasia 2 (9.52%)