| For the treatment of early esophageal squamous cell neoplasias (ESCNs), endoscopic submucosal dissection (ESD) enables en bloc resection of the neoplasia, and the resected specimen allows for a pathological assessment to evaluate the curability. However, ESD is a complicated procedure that requires a high level of expertise, and a long learning curve. Esophageal stenosis is still a serious concern after ESD, especially for those with lesions involving more than 3 quarters of the circumference. Radiofrequency ablation (RFA) is a rapidly evolving therapeutic modality, and recent studies have shown its efficacy and safety for eradicating dysplasia in cases of Barrett's esophagus as well as the early flat-type ESCNs. RFA appears to be less technically demanding, with a minimal learning curve compared with ESD, and thus may be more feasible for less experienced endoscopists. Also, radiofrequency energy for superficial ablation of early ESCNs has been successfully used to overcome the disadvantages of ESD with controlled thin-layer ablation, which avoids deep submucosal damage and has a much lower risk of stricture. Previously, we have demonstrated the good efficacy and safety for the ultra-long, extensive early ESCNs and in patients with well-compensated cirrhosis accompanied by esophageal varices. However, the major concern of RFA is no specimen to evaluate the curability after the treatment. Therefore, an accurate staging and patient selection are critically important. Currently, we suggest that RF A should be applied only for flat-type noninvasive neoplasia. |
