Successful balloon-based radiofrequency ablation of a widespread early squamous cell carcinoma and high-grade dysplasia of the esophagus: a case report

Background

For selected patients with high-grade dysplasia (HGD) and/or early esophageal squamous cell cancer (ESCC), endoscopic therapy represents a nonsurgical treatment option. For widespread lesions, however, current endoscopic treatment modalities (eg, endoscopic resection, argon plasma coagulation, photodynamic therapy) are associated with considerable drawbacks, of which esophageal stricturing is the most significant. Balloon-based radiofrequency (RF) ablation (HALO System) is a promising technology for endoscopic treatment of Barrett's esophagus, and may also play a role in treating widespread HGD and early ESCC.

Objective

We describe a case report of balloon-based RF ablation for HGD and early ESCC.

Design

Case report.

Setting

Tertiary care institution, Academic Medical Center, Amsterdam, The Netherlands.

Patient

A 66-year-old male with a 35-mm large, flat-type ESCC with surrounding HGD.

Intervention

Balloon-based RF ablation (HALO System).

Main Outcome Measurements

Endoscopic and histological eradication of HGD and ESCC, and adverse events.

Results

RF ablation resulted in complete endoscopic and histological eradication of HGD and ESCC without adverse events such as dysphagia or esophageal narrowing.

Limitations

Single patient report, limited follow-up.

Conclusions

This is the first report of balloon-based RF ablation for esophageal HGD and early ESCC. The treatment resulted in complete eradication of a 35-mm flat ESCC with no adverse events. This suggests that this ablation technique deserves further study for the management of widespread HGD or flat-type ESCC.

Abbreviations: APC, argon plasma coagulation, BE, Barrett's epithelium, EID, esophageal inner diameter, ER, endoscopic resection, ESCC, esophageal squamous cell cancer, HGD, high-grade dysplasia, NBI, narrow-band imaging, PDT, photodynamic therapy, RF, radiofrequency