The Efficacy and Safety of Endoscopic Submucosal Dissection (ESD) Combined With Radiofrequency Ablation (RFA) Sequential Therapy for Extensive Esophageal Lesions

ABSTRACT Purpose This study aimed to evaluate the efficacy and safety of a sequential treatment combining endoscopic submucosal dissection (ESD) with radiofrequency ablation (RFA) for extensive esophageal lesions, focusing on reducing esophageal stenosis and improving patients' quality of life. Methods We conducted a retrospective analysis of patients with extensive esophageal lesions who underwent sequential treatment of ESD and RFA. Lesion characteristics were assessed using Lugol's iodine staining, white‐light endoscopy, and ultrasound endoscopy. The non‐stained area was treated with ESD, and the remaining lightly stained area was subsequently treated with RFA. Results A total of 80 patients were enrolled in the study. The sequential therapy significantly reduced the incidence of esophageal stenosis compared to ESD monotherapy. The postoperative adverse events were lower in the sequential therapy group. There was no significant difference in postoperative recurrence rate between the two groups. Conclusion Sequential ESD‐RFA therapy significantly reduces stricture rates (30% vs. 60%, p = 0.02) and improves 12‐month quality of life (SF‐36: 82.55 vs. 74.40, p = 0.001) compared to ESD monotherapy, while maintaining equivalent complete remission rates (100% vs. 96.7%, p = 0.16). This approach is particularly advantageous for lesions > 10 cm or involving > 3/4 circumference.