Clinical Research Of Endoscopic Radiofrequency Ablation For Treatment Of Flat Upper Gastrointestinal Mucosal Lesions

Part Ⅰ.Outcomes of endoscopic radiofrequency ablation versus endoscopic submucosal dissection for early esophageal squamous cell carcinoma and high-grade intraepithelial neoplasiaObjective: Endoscopic submucosal dissection(ESD)is the mainstay treatment for early esophageal squamous cell carcinoma(ESCC)and high-grade intraepithelial neoplasia(HGIN),which carries a risk of severe stenosis,especially for patients with extensive lesions.Endoscopic radiofrequency ablation(ERFA)is a treatment option for early ESCC and HGIN,with potential low risk of stenosis,but the long-term outcomes remain unclear.We aimed to compare long-term outcomes of patients with early ESCC and HGIN who were treated with ESD or ERFA.Methods: The study included patients with a diagnosis of 0-IIb esophageal intramucosal carcinoma(IMC)and HGIN in Shanghai Changhai Hospital from January2015 to December 2021,who underwent ERFA or ESD,respectively.The primary outcome was recurrence-free survival(RFS).The secondary outcomes included overall survival(OS),disease-specific survival(DSS),complete response(CR)at 12 months,and complications.Results:In total,92 and 33 patients underwent ESD and ERFA,respectively.The mean age of patients in ESD group was(68.4± 8.5)years,and 71.7% were male.The mean age of patients in the ERFA group was(66.9±10.4)years,and 69.7% were male.The en bloc,R0,and curative resection rates for ESD were 100.0%(92/92),90.2%(83/92),and 76.1%(70/92),respectively.The CR rate at 3 months for ERFA was 78.8%.At12 months,the CR rate was comparable between the two groups(94.6% vs.90.9%,P=0.748).All patients were followed until 31 December 2022.The overall median follow-up was55 months(IQR,28-71 months),with a median follow-up of 69 months(IQR,32-75 months)in the ERFA group and 47 months(IQR,28-68 months)in the ESD group.Kaplan-Meier analysis showed that the RFS in ERFA group was significantly shorter than that in ESD group(P=0.007).There was no significant difference in OS(P=0.811)and DSS(P=0.516)between the two groups.Further subgroup analysis showed that in patients with lesion ≥3/4esophageal circumference(P=0.623)and lesion length ≥7 cm(P=0.949),RFS in the ERFA group was comparable to that in the ESD group,and the difference was not statistically significant.Preoperative diagnosis of IMC(HR=5.55,95% CI:1.83-16.81,P=0.002)was an independent predictor of recurrence.In lesions ≥ 3/4 circumference,the ERFA group had a significantly lower stenosis rate than the ESD group(33.3% vs.71.0%,P=0.015)and required significantly fewer endoscopic balloon dilation(median,4.0 vs.7.0,P=0.016).Conclusion: ERFA was associated with a higher risk of recurrence than ESD for early ESCC and HGIN without affecting patient survival.For flat early ESCC and HGIN,ERFA could be considered as a treatment choice for those with lesions ≥3/4 esophageal circumference and excessive length,upon careful preoperative evaluation and close postoperative follow-up.Part Ⅱ.Efficacy and safety of endoscopic radiofrequency ablation for chronic atrophic gastritis: a single-center,prospective cohort studyObjective: Chronic atrophic gastritis(CAG)is a common disease with high incidence in China.It is closely related to the occurrence of gastric cancer and is the precancerous state of gastric cancer.Therefore,early treatment of CAG is the key to prevent its progression to gastric cancer and reduce the incidence of gastric cancer.However,there is no specific treatment for CAG at present.ERFA has been applied to the treatment of CAG.However,there are few previous studies and the efficacy needs to be further clarified.Therefore,the aim of this study was to evaluate the short-term efficacy of ERFA for CAG.Methods: This prospective cohort study included patients who underwent ERFA for severe CAG in Shanghai Changhai Hospital from October 1,2015 to December 31,2021,and were followed up for at least 1 year.The primary outcome was the overall improvement rate.The secondary outcomes included atrophy improvement rate,intestinal metaplasia improvement rate,symptom score,changes in serological parameters,and procedurerelated complications.Results:Forty-two patients were included in the final analysis.There were 27 males and 15 females.The mean age of all patients was(61.6±8.3)years,the median duration of disease was 3 years(IQR,2-5 years),and the mean BMI was(23.1±7.5)kg/m2.More than half of the patients(64.3%)had a history of Hp infection.The common symptoms were epigastric pain,abdominal distension,acid reflux,belching,postprandial fullness and nausea.There were 16.7%(7/42)patients without special clinical symptoms,which were found by endoscopy.Nine patients(21.4%)had abdominal pain,with pain scores ranging from 2 to 6.Among them,5 patients disappeared after pain relief treatment,and the other 4 patients did not need special treatment.At 3 months,the improvement rates of atrophy and intestinal metaplasia were 81.0%(34/42)and 73.8%(31/42)respectively,and the overall improvement rate was 85.7%(36/42).At 6 months,the improvement rates of atrophy and intestinal metaplasia were 76.2%(32/42)and 66.7%(28/42),respectively,and the overall improvement rate was 78.6%(33/42).At 12 months,the improvement rates of atrophy and intestinal metaplasia were 69.0%(29/42)and 61.9%(26/42)respectively,and the overall improvement rate was 71.4%(30/42).The symptom scores at 3 months(P=0.002),6 months(P<0.001)and 12 months(P<0.001)were significantly lower than those before ERFA.The levels of PG Ⅰ,PGR and G-17 at 3,6 and 12 months after ERFA were higher than those before operation(P<0.05).The proportion of high risk stage(Ⅲ-Ⅳ)of OLGA and OLGIM at 12 months after ERFA was significantly lower than that before operation(P<0.001).Conclusion: ERFA is a safe and effective endoscopic treatment for severe CAG with significant short-term efficacy.