Endoscopic radiofrequency ablation (RFA) has shown good efficacy and safety in eradicating flat-type early esophageal squamous cell neoplasia (ESCN). However, post-RFA stricture is still a major concern, especially when treating ultralong-segment ESCNs. The aim of this study was to investigate the efficacy and safety of oral prednisolone to prevent post-RFA stricture. We prospectively enrolled 48 patients treated with balloon-type RFA who had Lugol-unstained or mosaic-like flat-type ESCNs with an expected treatment area of >10 cm. Oral prednisolone was started at a dose of 30 mg/day on the third day after RFA and continued for 4 weeks. The results were compared with an historical control group of 25 patients who received RFA without oral steroids. The primary endpoint was the frequency of post-RFA stricture. Secondary endpoints were the number of balloon dilation sessions and adverse event rate. No significant differences were found in the worst pathology grade at baseline and length of unstained lesions between the 2 groups. The complete response rates after 1 session of RFA were 73% and 72%, respectively. Compared with the control group, the oral prednisolone group had a significantly lower stricture rate (4% [2/48 patients] vs 44% [11/25 patients]; < .0001) and a lower number of balloon dilation sessions (median, 0 [range, 0-4] vs 6 [range, 0-10]). Two cases of asymptomatic candida esophagitis occurred in the study group, but no severe adverse effects. Oral prednisolone may offer a useful and safe preventive option for post-RFA stricture in ultralong ESCNs. (Clinical trial registration number: NCT05768282.)

中文翻译：

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口服泼尼松龙预防超长节段食管肿瘤球囊射频消融术后食管狭窄


内镜射频消融（RFA）在根除扁平型早期食管鳞状细胞瘤（ESCN）方面显示出良好的疗效和安全性。然而，RFA 后狭窄仍然是一个主要问题，特别是在治疗超长段 ESCN 时。本研究的目的是调查口服泼尼松龙预防 RFA 后狭窄的有效性和安全性。我们前瞻性地招募了 48 名接受球囊型 RFA 治疗的患者，这些患者的预期治疗面积 > 10 cm，具有 Lugol 未染色或马赛克状扁平型 ESCN。 RFA 后第三天开始口服泼尼松龙，剂量为 30 mg/天，持续 4 周。结果与历史对照组（由 25 名接受 RFA 且未口服类固醇的患者组成）​​进行了比较。主要终点是 RFA 后狭窄的频率。次要终点是球囊扩张次数和不良事件发生率。两组之间的基线最差病理分级和未染色病变长度没有发现显着差异。 1 次 RFA 后的完全缓解率分别为 73% 和 72%。与对照组相比，口服泼尼松龙组的狭窄率显着降低（4% [2/48 患者] vs 44% [11/25 患者]；< .0001），球囊扩张次数也较少（中位， 0 [范围，0-4] 与 6 [范围，0-10]）。研究组出现2例无症状念珠菌性食管炎，但未出现严重不良反应。口服泼尼松龙可能为超长 ESCN 术后 RFA 狭窄提供有用且安全的预防选择。 （临床试验注册号：NCT05768282。）