Systematic review and meta-analysis: The efficacy and safety of radiofrequency ablation combined with endoscopic resection for early superficial esophageal squamous cell neoplasia

Background: Esophageal squamous cell neoplasia (ESCN) is the sixth leading cause of cancer deaths worldwide, with patients experiencing a decrease in life expectancy. Radiofrequency ablation (RFA) and endoscopic resection (ER) have each been recommended for treatment of early superficial ESCN in the available clinical guidelines; however, the combined application of RFA and ER for treatment of early superficial ESCN remains inconclusive. We performed a meta-analysis to investigate the efficacy of RFA combined with ER in patients diagnosed with early superficial ESCN. Methods: Three major bibliographic databases were reviewed for enrollment of case series and cohort studies before September 17, 2023. We included adults with early superficial ESCN who were receiving a combination of RFA and ER, focusing on their end-of-treatment histological complete response (CR), as well as both acute and late postoperative adverse events (AEs) at the follow-up period. Results: Five studies involving a total of 382 participants for analysis were used. The end-of-treatment histological CR, acute and late postoperative AEs were 91% (95% CI, 0.87-0.93), 6% (95% CI, 0.02-0.17), and 21% (95% CI, 0.05-0.57), respectively. With respect to safety, stricture was most commonly encountered. In subgroup analysis, sequential ER followed by RFA achieved similar end-of-treatment histological CR as well as higher acute and later complications postoperatively. Conclusions: For patients diagnosed with early superficial ESCN, endoscopic RFA combined with ER achieved both a feasible end-of-treatment histological CR and tolerable complications postoperatively. The combination of endoscopic RFA and ER may therefore be considered as an alternative choice, although its role in clinical practice remains inconclusive.