GIE Associate Editor Seiichiro Abe, MD, highlights this article from the June issue: “Endoscopic background mucosal resurfacing to prevent metachronous recurrence of superficial esophageal squamous cell cancer after curative endoscopic submucosal dissection: randomized pilot study with 5-year follow-up (with video)” by Wen-Lun Wang, MD, PhD, et al.

Endoscopic submucosal dissection (ESD) has become the standard curative treatment option for superficial esophageal squamous cell carcinoma (ESCC) to preserve the esophagus. However, the risk of metachronous recurrence after ESD is high, particularly in patients with multiple (>10) Lugol-voiding lesions (LVLs), which appear as a speckled Lugol staining pattern over the endoscopic background mucosa. Although lifelong periodic surveillance endoscopy is recommended, it places a significant burden on patients and endoscopists.

Radiofrequency ablation (RFA) is an effective and safe modality for eliminating dysplasia or intestinal metaplasia in Barrett’s esophagus, but little is known about pre-emptive RFA for the entire background mucosa (endoscopic background mucosal resurfacing [EBMR]) for prevention of metachronous recurrence of ESCC after ESD.

To address this issue, Wang et al conducted a single-center randomized controlled trial to investigate the effectiveness of EBMR for patients with multiple LVLs after ESD. The primary endpoint was metachronous tumor recurrence after curative ESD over a 5-year follow-up. EBMR significantly reduced the risk of metachronous recurrence (see the graphical abstract). Reversal of the multiple LVL pattern to only a few LVLs occurred in all patients.

EBMR using RFA is a novel and promising approach to prevent metachronous recurrence of ESCC after ESD for high-risk patients. Clinicians should further assess the risk of post-EBMR stricture after extensive RFA, optimal stricture prevention, and the technical challenge of performing ESD in the case of metachronous recurrence after EBMR. Further multicenter prospective validation studies are warranted.

Graphical abstract

Read the full article online.

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