Post written by Mako Koseki, MD, from the Gastroenterology, Hepatology, and Nutrition Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA, and the Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, and Makoto Nishimura, MD, from the Gastroenterology, Hepatology, and Nutrition Service, Memorial Sloan Kettering Cancer Center.

In the United States, radiofrequency ablation (RFA) is a well-established treatment for dysplasia caused by Barrett’s esophagus (BE). Similarly, endoscopic submucosal dissection (ESD) has been widely performed for nodular mucosal dysplasia and early carcinomas.

Although previous data suggest the feasibility of ESD as post-chemoradiation therapy, information about the outcomes of ESD conducted after RFA is limited. Therefore, this study aimed to assess the feasibility and safety of ESD in patients with prior RFA treatment.

It is estimated that approximately 5.6% of the U.S. population has BE. Many patients undergo RFA and cryotherapy for treatment of dysplastic BE. Because of the higher frequency of RFA performed in Western countries than East Asia, where ESD is more prevalent, the evidence behind patients who have a history of RFA but require ESD is unclear. As part of a facility that conducts numerous cases of both RFA and ESD, we were motivated to undertake this study.

All cases achieved en bloc resection, with 6 of 7 cases achieving R0 resection. No adverse events such as pneumonia, perforation, or delayed bleeding were observed post-ESD. Furthermore, none of the patients experienced recurrences at the 1-year follow-up, thereby enabling patients to avoid esophagectomy. The 1 case that did not achieve R0 resection underwent brachytherapy after ESD, with no subsequent recurrences.

Our next step is comparing the long-term outcomes of patients who underwent ESD versus those who underwent other nondissection treatments.

The strength of ESD lies in its ability to provide a complete pathological assessment of the lesion by dissecting the entire area. RFA and cryotherapy are effective techniques for treating early lesions, but the certainty of achieving curative resection with these methods is unclear. Therefore, ESD proves to be particularly valuable in such cases.

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