Predictors for postoperative esophageal stricture after balloon-based radiofrequency ablation for early esophageal squamous neoplasia: A multicenter validation study

Wen Lun Wang, I. Wei Chang, Chien Chuan Chen, Wei Lun Chang, Yin Yi Chu, Ping Hsiu Wu, Wei Chen Tai, Po Yueh Chen, Ping Hsin Hsieh, Chen Shuan Chung, Chi Yang Chang, Jaw Town Lin, Hsiu Po Wang, Ching Tai Lee

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Endoscopic radiofrequency ablation (RFA) is a rapidly evolving therapeutic modality for early flat esophageal squamous cell neoplasms (ESCNs), but the risk factors for postoperative stricture have not been elucidated. The objective of this study was to identify and validate a predictor for post-RFA stenosis. Methods: We consecutively enrolled patients with flat-type 'large' (length no less than 3 cm extending no less than half the circumference of the esophagus), early ESCNs, treated with balloon-based RFA (12 J/cm 2 -clean-12 J/cm 2 regimen). The tumor and technical factors for postoperative stricture were investigated and we validated the results externally with a society-based multicenter cohort using the same ablation regimen. Results: A total of 51 patients were enrolled (30 in the development set and 21 in the validation set). The complete remission rate at 12 months was 93%, and the rates of perforation and postoperative stenosis were 0% and 17%, respectively. Patients with post-RFA stenosis had a significantly larger longitudinal tumor size (mean 115 versus 61 mm, p = 0.003). There were no significant differences in age, body mass index, tumor circumferential extension, pretreatment histological grade, treatment efficacy or size of balloon catheter between the groups with or without stenosis. The optimal cut-off value was set as 9 cm to predict post-RFA stenosis by receiver operating characteristic curve [area under curve (AUC) = 0.881], which was then confirmed to be a reliable predictor by multivariate analysis (odds ratio, 12.7, 95% confidence interval, 1.18-136.28, p = 0.03) and have a good predictive performance in the validation set (AUC = 0.876). Conclusions: The most frequent adverse event of RFA was esophageal stenosis, for which the longitudinal tumor size was a significant predictive factor. Early intervention or prevention for stricture should be applied for those with long segment (â3/49 cm) ESCNs.

Original languageEnglish
Pages (from-to)257-264
Number of pages8
JournalTherapeutic Advances in Gastroenterology
Volume9
Issue number3
DOIs
Publication statusPublished - 2016 Jan 1

Fingerprint

Esophageal Stenosis
Validation Studies
Multicenter Studies
Pathologic Constriction
Squamous Cell Neoplasms
Neoplasms
Esophageal Neoplasms
Area Under Curve
ROC Curve
Esophagus
Body Mass Index
Multivariate Analysis
Catheters
Odds Ratio
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

Wang, Wen Lun ; Chang, I. Wei ; Chen, Chien Chuan ; Chang, Wei Lun ; Chu, Yin Yi ; Wu, Ping Hsiu ; Tai, Wei Chen ; Chen, Po Yueh ; Hsieh, Ping Hsin ; Chung, Chen Shuan ; Chang, Chi Yang ; Lin, Jaw Town ; Wang, Hsiu Po ; Lee, Ching Tai. / Predictors for postoperative esophageal stricture after balloon-based radiofrequency ablation for early esophageal squamous neoplasia : A multicenter validation study. In: Therapeutic Advances in Gastroenterology. 2016 ; Vol. 9, No. 3. pp. 257-264.
@article{c77a41f390544d8384cbcd3b9d852f11,
title = "Predictors for postoperative esophageal stricture after balloon-based radiofrequency ablation for early esophageal squamous neoplasia: A multicenter validation study",
abstract = "Background: Endoscopic radiofrequency ablation (RFA) is a rapidly evolving therapeutic modality for early flat esophageal squamous cell neoplasms (ESCNs), but the risk factors for postoperative stricture have not been elucidated. The objective of this study was to identify and validate a predictor for post-RFA stenosis. Methods: We consecutively enrolled patients with flat-type 'large' (length no less than 3 cm extending no less than half the circumference of the esophagus), early ESCNs, treated with balloon-based RFA (12 J/cm 2 -clean-12 J/cm 2 regimen). The tumor and technical factors for postoperative stricture were investigated and we validated the results externally with a society-based multicenter cohort using the same ablation regimen. Results: A total of 51 patients were enrolled (30 in the development set and 21 in the validation set). The complete remission rate at 12 months was 93{\%}, and the rates of perforation and postoperative stenosis were 0{\%} and 17{\%}, respectively. Patients with post-RFA stenosis had a significantly larger longitudinal tumor size (mean 115 versus 61 mm, p = 0.003). There were no significant differences in age, body mass index, tumor circumferential extension, pretreatment histological grade, treatment efficacy or size of balloon catheter between the groups with or without stenosis. The optimal cut-off value was set as 9 cm to predict post-RFA stenosis by receiver operating characteristic curve [area under curve (AUC) = 0.881], which was then confirmed to be a reliable predictor by multivariate analysis (odds ratio, 12.7, 95{\%} confidence interval, 1.18-136.28, p = 0.03) and have a good predictive performance in the validation set (AUC = 0.876). Conclusions: The most frequent adverse event of RFA was esophageal stenosis, for which the longitudinal tumor size was a significant predictive factor. Early intervention or prevention for stricture should be applied for those with long segment ({\^a}3/49 cm) ESCNs.",
author = "Wang, {Wen Lun} and Chang, {I. Wei} and Chen, {Chien Chuan} and Chang, {Wei Lun} and Chu, {Yin Yi} and Wu, {Ping Hsiu} and Tai, {Wei Chen} and Chen, {Po Yueh} and Hsieh, {Ping Hsin} and Chung, {Chen Shuan} and Chang, {Chi Yang} and Lin, {Jaw Town} and Wang, {Hsiu Po} and Lee, {Ching Tai}",
year = "2016",
month = "1",
day = "1",
doi = "10.1177/1756283X16633051",
language = "English",
volume = "9",
pages = "257--264",
journal = "Therapeutic Advances in Gastroenterology",
issn = "1756-283X",
publisher = "SAGE Publications Ltd",
number = "3",

}

Predictors for postoperative esophageal stricture after balloon-based radiofrequency ablation for early esophageal squamous neoplasia : A multicenter validation study. / Wang, Wen Lun; Chang, I. Wei; Chen, Chien Chuan; Chang, Wei Lun; Chu, Yin Yi; Wu, Ping Hsiu; Tai, Wei Chen; Chen, Po Yueh; Hsieh, Ping Hsin; Chung, Chen Shuan; Chang, Chi Yang; Lin, Jaw Town; Wang, Hsiu Po; Lee, Ching Tai.

In: Therapeutic Advances in Gastroenterology, Vol. 9, No. 3, 01.01.2016, p. 257-264.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Predictors for postoperative esophageal stricture after balloon-based radiofrequency ablation for early esophageal squamous neoplasia

T2 - A multicenter validation study

AU - Wang, Wen Lun

AU - Chang, I. Wei

AU - Chen, Chien Chuan

AU - Chang, Wei Lun

AU - Chu, Yin Yi

AU - Wu, Ping Hsiu

AU - Tai, Wei Chen

AU - Chen, Po Yueh

AU - Hsieh, Ping Hsin

AU - Chung, Chen Shuan

AU - Chang, Chi Yang

AU - Lin, Jaw Town

AU - Wang, Hsiu Po

AU - Lee, Ching Tai

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Background: Endoscopic radiofrequency ablation (RFA) is a rapidly evolving therapeutic modality for early flat esophageal squamous cell neoplasms (ESCNs), but the risk factors for postoperative stricture have not been elucidated. The objective of this study was to identify and validate a predictor for post-RFA stenosis. Methods: We consecutively enrolled patients with flat-type 'large' (length no less than 3 cm extending no less than half the circumference of the esophagus), early ESCNs, treated with balloon-based RFA (12 J/cm 2 -clean-12 J/cm 2 regimen). The tumor and technical factors for postoperative stricture were investigated and we validated the results externally with a society-based multicenter cohort using the same ablation regimen. Results: A total of 51 patients were enrolled (30 in the development set and 21 in the validation set). The complete remission rate at 12 months was 93%, and the rates of perforation and postoperative stenosis were 0% and 17%, respectively. Patients with post-RFA stenosis had a significantly larger longitudinal tumor size (mean 115 versus 61 mm, p = 0.003). There were no significant differences in age, body mass index, tumor circumferential extension, pretreatment histological grade, treatment efficacy or size of balloon catheter between the groups with or without stenosis. The optimal cut-off value was set as 9 cm to predict post-RFA stenosis by receiver operating characteristic curve [area under curve (AUC) = 0.881], which was then confirmed to be a reliable predictor by multivariate analysis (odds ratio, 12.7, 95% confidence interval, 1.18-136.28, p = 0.03) and have a good predictive performance in the validation set (AUC = 0.876). Conclusions: The most frequent adverse event of RFA was esophageal stenosis, for which the longitudinal tumor size was a significant predictive factor. Early intervention or prevention for stricture should be applied for those with long segment (â3/49 cm) ESCNs.

AB - Background: Endoscopic radiofrequency ablation (RFA) is a rapidly evolving therapeutic modality for early flat esophageal squamous cell neoplasms (ESCNs), but the risk factors for postoperative stricture have not been elucidated. The objective of this study was to identify and validate a predictor for post-RFA stenosis. Methods: We consecutively enrolled patients with flat-type 'large' (length no less than 3 cm extending no less than half the circumference of the esophagus), early ESCNs, treated with balloon-based RFA (12 J/cm 2 -clean-12 J/cm 2 regimen). The tumor and technical factors for postoperative stricture were investigated and we validated the results externally with a society-based multicenter cohort using the same ablation regimen. Results: A total of 51 patients were enrolled (30 in the development set and 21 in the validation set). The complete remission rate at 12 months was 93%, and the rates of perforation and postoperative stenosis were 0% and 17%, respectively. Patients with post-RFA stenosis had a significantly larger longitudinal tumor size (mean 115 versus 61 mm, p = 0.003). There were no significant differences in age, body mass index, tumor circumferential extension, pretreatment histological grade, treatment efficacy or size of balloon catheter between the groups with or without stenosis. The optimal cut-off value was set as 9 cm to predict post-RFA stenosis by receiver operating characteristic curve [area under curve (AUC) = 0.881], which was then confirmed to be a reliable predictor by multivariate analysis (odds ratio, 12.7, 95% confidence interval, 1.18-136.28, p = 0.03) and have a good predictive performance in the validation set (AUC = 0.876). Conclusions: The most frequent adverse event of RFA was esophageal stenosis, for which the longitudinal tumor size was a significant predictive factor. Early intervention or prevention for stricture should be applied for those with long segment (â3/49 cm) ESCNs.

UR - http://www.scopus.com/inward/record.url?scp=84963727768&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84963727768&partnerID=8YFLogxK

U2 - 10.1177/1756283X16633051

DO - 10.1177/1756283X16633051

M3 - Article

AN - SCOPUS:84963727768

VL - 9

SP - 257

EP - 264

JO - Therapeutic Advances in Gastroenterology

JF - Therapeutic Advances in Gastroenterology

SN - 1756-283X

IS - 3

ER -