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Background and study aims Endoscopic radiofrequency ablation (RFA) is an established therapy for Barrett’s esophagus. Preliminary reports, limited by low patient numbers, suggest a possible role for RFA for early esophageal squamous cell neoplasia (ESCN), as well. The aim of this study was to evaluate the safety and effectiveness of RFA for early ESCN [moderate-grade/high-grade intraepithelial neoplasia (MGIN/HGIN) and early flat-type esophageal squamous cell carcinoma (ESCC)]. Patients and methods In this prospective cohort study, patients had ≥1 flat (type 0-IIb) unstained lesion (USL) on Lugol’s chromoendoscopy and a consensus diagnosis of MGIN, HGIN, or early ESCC. RFA was used at baseline to treat all USLs, then biopsy (and focal RFA if USL(s) persisted) was performed every 3 months until all biopsies were negative for MGIN, HGIN and ESCC. The main outcome measurements were complete response (CR) at 3 and 12 months (absence of MGIN, HGIN, and ESCC), neoplastic progression, and adverse events. Results 96 patients participated (MGIN 45, HGIN 42, early ESCC 9). At 3 and 12 months, respectively, 73% (70/96) and 84% (81/96) were CR. Two patients (2%) progressed (MGIN to HGIN; HGIN to T1m2 ESCC); both were treated endoscopically and achieved CR. Stricture occurred in 20 patients (21%), all after circumferential RFA. Lugol’s + RFA 12 J/cm2 (single application, no cleaning) was the favored baseline circumferential RFA technique (82% 12-month CR, 6% stricture). Conclusion In patients with early ESCN, RFA is associated with a high CR rate and acceptable safety profile.

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Important evidence indicates that the microbiota plays a key role in esophageal squamous cell carcinoma (ESCC). Here, paired saliva and brush specimens were obtained from 276 participants undergoing upper gastrointestinal endoscopic examination before or during screening for upper gastrointestinal (UGI) cancer. The esophageal microbiota was investigated by 16S rRNA gene profiling and next-generation sequencing. We observed that as the disease progressed, the α diversity in the saliva and cell brush samples decreased. Linear discriminant analysis effect size (LEfSe) results showed that in both the saliva and cell brush specimens, Granulicatella, Rothia, Streptococcus, Gemella, Leptotrichia and Schaalia were common biomarkers in patients with low-grade dysplasia, Lactobacillus was a common biomarker in patients with high-grade dysplasia, and Bosea, Solobacterium, Gemella, and Peptostreptococcus were common biomarkers in patients with esophageal cancer. The top 3 genera in the saliva and cell brush specimens had areas under the curve (AUCs) of 87.16 and 89.13%, respectively, to distinguish ESCC patients from normal people. The PICRUSt2 results identified in brush samples that patients with ESCC had decreased nitrate reductase functions. Our results suggest that future studies can focus on the function of the characteristic bacteria in ESCC.

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