Endoscopic Radiofrequency Ablation Research Articles

Systematic review and meta-analysis: the efficacy and safety of radiofrequency ablation for early superficial esophageal squamous cell neoplasia

Background and AimEsophageal squamous cell neoplasia (ESCN) is predominant in Asia. Endoscopic mucosal resection and endoscopic submucosal dissection (ESD) have both been recommended worldwide, however the application of endoscopic radiofrequency ablation (RFA) for treatment of early superficial ESCN remains inconclusive. We conducted a meta-analysis to study the effectiveness of RFA for early superficial ESCN.MethodsThree major bibliographic databases were reviewed for the enrollment of case series and cohort trials prior to August 23, 2023. We included adults diagnosed with early superficial ESCN who had been receiving endoscopic RFA or ESD if the treatments were available. Our focus was on the 12-month histological complete response rate (CR) and 3-month histological CR, as well as the acute and late postoperative adverse events (AEs) rate during the at follow-up periods.ResultsNine studies were enrolled for qualitative synthesis of narrative review, with eight trials involving a total of 447 participants for analysis. The pooled 12-month and 3-month histological CR were 0.83 (95% CI, 0.59–0.94, I2 = 80%) and 0.74 (95% CI, 0.67–0.80, I2 = 0%), respectively. As for safety, the acute and late postoperative AEs were 0.11 (95% CI, 0.05–0.26, I2 = 68%) and 0.19 (95% CI, 0.14–0.26, I2 = 0%), respectively. In subgroup analysis, the incidence of bleeding, laceration and perforation after endoscopic RFA showed 0.06, 0.06 and 0.02, respectively. When compared with ESD, RFA showed lower acute AEs and late AEs without any obvious significance.ConclusionsFor early superficial ESCN, endoscopic RFA achieved both higher 12-month complete remission and late complication postoperatively when compared to 3-month histological CR and acute AEs separately, while the stricture was encountered most commonly. The choice between endoscopic RFA and ESD remains inconclusive.

Endoscopic radiofrequency ablation of pancreatic neuroendocrine tumors

Aim. To present the first experience of EUS-guided radiofrequency ablation in the treatment of patients with functioning neuroendocrine tumors of the pancreas. Materials and methods. Endoscopic radiofrequency ablation was performed in 2 patients with insulin-producing neuroendocrine tumor of the pancreatic head and clinical picture of organic hyperinsulinism. The radiofrequency ablation system includes a 19-gauge needle electrode to be conducted through the forceps aperture, a generator and an intraelectrode cooling system. Results. The efficacy of ultrasound-guided radiofrequency ablation in the cases presented above appears to be clinically proven. The outcomes include stabilization of the blood glucose level, a complete elimination of hypoglycemia-associated clinical symptoms. Both observations reveal no complications after the procedure. Conclusion. EUS-guided radiofrequency ablation appears to possess a potential for wider application as a minimally invasive intervention, thus introducing an alternative to surgical treatment of patients with neuroendocrine tumors of the pancreas. An experience of EUS-guided radiofrequency ablation is worth to be accumulated and outcomes of the method application to be analyzed on a larger number of clinical observations.

First experience of endoscopic radiofrequency ablation in tumor-induced stenosis of extrahepatic bile ducts

Aim. To evaluate technical features, safety and efficiency of radiofrequency ablation in tumor strictures of extrahepatic bile ducts. Materials and methods. An ongoing prospective observational study from September 2022 to June 2023 enrolled patients with unresectable extrahepatic bile duct tumors. Examination involved esophagogastroduodenoscopy, endoscopic ultrasound, retrograde cholangiopancreatography and video choledochoscopy with biopsy. Ductalradiofrequency ablation with polymeric or self-expanding metallic stent placement was applied as the main treatment method for the first time in Russia. Results. 3 patients (75 %) were diagnosed with cholangiocarcinoma of stage IIb–IIIa, 1 patient – with mucinous cystic tumor with signs of severe intraepithelial neoplasia. Radiofrequency ablation was successfully performed in all patients: tumor stenosis was completely eliminated, no complications reported in the immediate and distant period. The median follow-up period amounted to 8 months. Conclusion. The results of the first application of ductal radiofrequency ablation in unresectable tumors of extrahepatic bile ducts with stenosis prove to be positive. The method is considered to be effective, minimally invasive and safe.

Consensus statements on endoscopic radiofrequency ablation for malignant biliary strictures.

Endoscopy-guided endobiliary radiofrequency ablation has emerged as a novel treatment for malignant biliary strictures in recent years. When combined with biliary stenting and systemic chemotherapy, it can effectively postpone local tumor progression, improve patient's quality of life, and prolong their survival, which is mainly indicated for patients with inoperable extrahepatic cholangiocarcinoma and ampullary cancer. Based on the existing clinical evidence, the Digestive Endoscopology Branch of Chinese Medical Association, the Digestive Endoscopy Professional Committee, Endoscopic Physicians Branch of Chinese Medical Doctor Association, and the National Clinical Research Center for Digestive Diseases (Shanghai) organized relevant experts to discuss the indications, contraindications, technical operation specifications, and prevention and treatment of the complications during endoscopy-guided endobiliary radiofrequency ablation. Consensus statements were established, trying to provide references for standard treatment of malignant biliary tumors in clinical practice.

Endoscopic radiofrequency ablation under the control of ultrasonography as a new method of treatment of neuroendocrine pancreatic tumors and analgesia option for locally advanced forms of pancreatic cancer. First experience in Russia

Background. Radiofrequency ablation (RFA) of pancreatic NET up to 20 mm in size under endosonographic control (EUS) may become the method of choice in the treatment of this group of patients, as well as an option for analgesia in patients with locally advanced forms of pancreatic cancer. Aim. Describe the RFA – EUS technique, evaluate the safety and efficacy of the RFA – EUS method in the treatment of NET of the pancreas, up to 2.0 cm in diameter, and ablation of the celiac plexus in a cohort of patients with locally advanced forms of pancreatic cancer in order to relieve pain. Materials and Methods. In a prospective ongoing observational study conducted at the FSBI “N. N. Blokhin national Medical Research Center of Oncology” of the Ministry of Health of Russia from September 2022 to June 2023, data of 10 patients with resectable NET and unresectable malignant neoplasms of the pancreas were analyzed. The main method of treatment in 100 % of cases was RFA – EUS, performed for the first time in Russia. All patients at the first stage underwent esophagogastroduodenoscopy (EGDS) and endosonographic study with fine needle aspiration biopsy (EUS-TAB) to verify the diagnosis. At the second stage, all patients underwent RFA – EUS. The main evaluated parameter in the group of patients with NET was the absence of residual tumor tissue after RFA – EUS, according to Endo-US and MRI, the nature of changes in the pancreatic tissue after RFA was additionally assessed – fibrous or necrotic changes in the area of RFA – EUS. The main parameter evaluated in the group of patients with unresectable pancreatic cancer was the absence of pain within 8 weeks. and complete withdrawal from opioid analgesics 3–5 days after RFA – EUS. Results. According to the results of a morphological study, the diagnosis of pancreatic NET was confirmed in 7 (70 %) patients, adenocarcinoma – in 3 (30 %). Technical success, defined as a complete endosonographic and radiological response 3 months after the intervention in the group of patients with pancreatic NET (n = 7; 70 %) and complete withdrawal of opioid analgesics at 3–5 days, with the preservation of the analgesic effect for 8 weeks. after RFA – EUS, was achieved in 100 % of cases (n = 3; 30 %). Return to opioid analgesics after 3 months RFA – EUS in the group of patients with adenocarcinoma of the pancreas (n = 3; 30 %) was noted in 20 % of cases (n = 2), which required re-intervention, in 10 % (n = 1) – it was not possible to estimate the duration of the analgesic effect due to the death of the patient 2 months after RFA – EUS, the median follow-up was 6 months. Conclusion. The results of the study are the first experience of using RFA – EUS in the treatment of malignant neoplasms of the pancreas. EUS-guided RFA is an effective, minimally invasive and safe treatment for pancreatic NET, up to 2.0 cm in diameter, as well as an analgesic option for advanced pancreatic cancer. To determine the indications, contraindications and effectiveness of RFA in the radical and symptomatic treatment of malignant neoplasms of the pancreas, it is necessary to conduct large prospective multicenter studies.

Is endoscopic radiofrequency ablation plus stent placement superior to stent placement alone for the treatment of malignant biliary obstruction? A systematic review and meta-analysis.

Malignant biliary obstruction (MBO) is a rare disease with a poor prognosis. Recent studies have shown that endoscopic radiofrequency ablation (ERFA) may improve survival. We conducted a systematic review and meta-analysis of the efficacy of ERFA in combination with biliary stent placement for the treatment of MBO. The study was registered in INPLASY (number 202340096). The PubMed, Cochrane Library, Web of Science, and Embase databases were searched from inception to April 2023. We selected studies comparing the efficacy of ERFA plus stent placement with stent placement alone. The primary outcomes were pooled hazard ratios (HRs) for overall survival and stent patency; the secondary outcomes were the odds ratios (ORs) for adverse events. Eleven studies (four randomized controlled trials and seven observational studies) were included in the meta-analysis. Pooled analysis showed a difference in survival time between the two groups (HR 0.65, 95% confidence interval [CI] 0.58-0.73, I2 = 40%). However, there were no differences in the duration of stent patency or the incidence of adverse events (HR 1.04, 95% CI 0.84-1.29, I2 = 46%; OR 1.41, 95% CI 1.02-1.96, I2 = 29%). ERFA has a significant survival benefit for MBO, but does not increase the risk of adverse events.

Comparison between ESD and RFA in patients with total or near-total circumferential early esophageal squamous cell neoplasia.

Patients with early esophageal squamous cell neoplasias (ESCNs) that are totally or nearly totally circumferential face challenges in their clinical work. Endoscopic submucosal dissection (ESD) frequently leads to esophageal strictures. Endoscopic radiofrequency ablation (RFA), which stands out for its simplicity of use and low rate of stenosis, is a rapidly evolving therapeutic strategy for early ESCNs. We contrast ESD with RFA in order to find which method is best for the treatment of a wide range of esophageal diseases. Patients who had flat-type, early, large ESCNs (extending more than 3/4 of the esophageal circumference) treated endoscopically were enrolled retrospectively. The primary outcome measurements were adverse events and local control of the neoplastic lesion. A total of 105 patients received treatment; 60 had ESD and 45 received RFA. Despite the patients receiving RFA typically having larger tumors (14.27 vs. 5.70cm, P < 0.05), the local control of the neoplastic lesion and procedure-related complications were comparable between the ESD and RFA groups. A considerably higher risk of esophageal stenosis was observed in patients with extensive lesions in the ESD group compared to the RFA group (60% vs. 31%; P < 0.05), and the rate of refractory stricture is also higher than that of the RFA. Both RFA and ESD are effective in treating large, flat, early ESCNs; however, ESD is more likely to cause side effects, such as esophageal stricture, particularly in lesions that are larger than 3/4 of the diameter. Before RFA, a more precise and thorough pretreatment examination should be performed. A more accurate pretreatment evaluation will be an important development direction for early esophageal cancer in future. After surgery, a strict routine review is crucial.

Endoscopic biliary treatment of unresectable cholangiocarcinoma: A meta-analysis of survival outcomes and systematic review.

Endoscopic radiofrequency ablation (ERFA), percutaneous radiofrequency ablation (PRFA), and photodynamic therapy (PDT), when used in conjunction with conventional biliary stenting, have demonstrated a survival benefit in patients with unresectable cholangiocarcinoma. To compare pooled survival outcomes, adverse event rates, and mean stent patency for those undergoing these procedures. A comprehensive literature review of published studies and abstracts from January 2011 to December 2020 was performed comparing survival outcomes in patients undergoing ERFA with stenting, biliary stenting alone, PRFA with stenting, and PDT with stenting for unresectable cholangiocarcinoma (CCA). Data from four studies demonstrated a pooled mean survival favoring ERFA as compared to biliary stenting alone (12.0 ± 0.9 mo vs 6.8 ± 0.3 mo, P < 0.001) as well as statistically improved median survival time (13 mo vs 8 mo, P < 0.001). Both ERFA with stenting and PRFA with stenting groups demonstrated statistical superiority to biliary stenting alone (P < 0.001 and P = 0.004, respectively). However, when comparing ERFA to PRFA, pooled data demonstrated overall higher mean survival in the ERFA with stenting cohort as compared to PRFA with stent cohort (12.0 + 0.9 mo vs 8.1 + 2.1 mo, P < 0.0001). Data from two studies demonstrated a pooled median survival favoring ERFA with stenting as compared to PDT with stenting (11.3 mo vs 8.5 mo, P = 0.02). While further prospective, randomized studies are needed to assess efficacy of ERFA, our meta-analysis demonstrated that this technique offers endoscopists a reasonable palliative method by which to treat patients with unresectable CCA that results in longer survival as compared to biliary stenting alone, percutaneous radiofrequency ablation with biliary stenting, and PDT with biliary stenting as well as an acceptable adverse event profile based on available published data.

Radiofrequency ablation for pancreatobiliary disease: an updated review.

Endoscopic radiofrequency ablation (RFA) has emerged as a minimally invasive treatment option in cases of malignant biliary obstruction, pancreatic cancer, and other pancreatic cystic neoplasms. Intraductal biliary RFA is safe, effective, and confers a survival advantage over stenting alone, where it should be used an adjunct to biliary stenting. Endoscopic ultrasound-guided RFA can also provide pancreatic cyst resolution in patients who are not ideal operative candidates. The aim of this review is to describe the endoscopic applications and associated outcomes of RFA.

Biportal Endoscopic Radiofrequency Ablation of the Sacroiliac Joint Complex in the Treatment of Chronic Low Back Pain: A Technical Note with 1-Year Follow-Up.

Sacroiliac joint (SIJ) pain is a common source of low back pain. Previously reported management strategies for this pain include conservative treatment, SIJ injection, radiofrequency denervation ablation, and SIJ fusion. Herein, we describe the use of biportal endoscopic radiofrequency ablation (BERA) to treat patients with low back pain. We included 16 patients who underwent BERA from April 2018 to June 2020. We marked the S1, S2, and S3 foramina and the SIJ line under fluoroscopy. Skin entry points were positioned at 0.5 cm medial to the SIJ line and at the level of the S1 and S2 foramina. Under local anesthesia, we introduced a 30° arthroscope with a 4 mm diameter through the viewing portal; surgical instruments were inserted through another caudal working portal. We ablated the lateral branches of the S1-S3 foramina and L5 dorsal ramus, which were the sources of SIJ pain. Clinically relevant improvements in both visual analog scale and Oswestry Disability Index scores were noted at 1-, 6-, and 12-month follow-up time points after surgery. The overall patient satisfaction score was 89.1%. BERA for SIJ pain treatment has the advantage of directly identifying and ablating the innervating nerve to the joint. Through this technique, an expanded working angle can be obtained compared with traditional single-port endoscopy. Our study demonstrated promising preliminary results.

The first Russian experience of radiofrequency ablation in the treatment of adenoma of the major duodenal papilla with intraductal growth in the common bile duct

Adenoma of the major duodenal papilla can cause bile flow blockade and obstructive jaundice. We present successful endoscopic radiofrequency ablation for adenoma of the major duodenal papilla with intraductal growth in the common bile duct.

Endoscopic radiofrequency ablation for ingrowth occlusion after bilateral metal stent placement for malignant hilar biliary obstruction: a prospective pilot study

Endoscopic biliary radiofrequency ablation (RFA) may be an option for the treatment of ingrowth occlusion after self-expandable metal stent (SEMS) deployment; however, its utility remains uncertain. This study aimed to examine the feasibility of RFA for the palliation of ingrowth after bilateral SEMS placement in patients with malignant hilar biliary obstruction. This prospective, single-center, pilot study enrolled 30 patients who met the eligibility criteria between April 2020 and March 2022. Study outcomes were technical success, clinical success, recurrent biliary obstruction (RBO), and adverse events (AEs) besides RBO associated with RFA for ingrowth occlusion. Furthermore, factors predictive of clinical success were evaluated. Technical and clinical success rates were 93.3% (28/30) and 71.4% (20/28), respectively. The rates of early and late AEs were 6.7% (2/30) and 10.0% (2/20), respectively. The incidence rate of RBO after RFA was 45.0% (9/20), and the median time to RBO was 163 days. Multivariate analysis of the factors affecting clinical success revealed a positive association between the recanalization diameter on the ingrown part within the SEMS (odds ratio, 1.13; 95% confidence interval, 1.01-1.26; P= .038). The calculated optimal cutoff for the ratio of the recanalization diameter to the SEMS diameter for predicting clinical success was 51.1%. Endoscopic biliary RFA elicited promising results, with good long-term stent patency and without the requirement of any additional stent placement, for the palliation of ingrowth occlusion after bilateral SEMS placement. However, the clinical success rate was insufficient, necessitating improvements in the future. (Clinical trial registration number: UMIN000040154.).

Optimal reproduction of a porcine benign biliary stricture model using endobiliary radiofrequency ablation

The use of endobiliary radiofrequency ablation (RFA) to generate a benign biliary stricture (BBS) model has a significant reproducibility problem. The aims of this animal study were to create an optimal BBS model using endobiliary RFA and determine the best way to develop it. The first step was performed on the common bile duct (CBD) of 10 miniature pigs using endoscopic RFA with a target temperature-controlled mode (80 ℃, 7 W for 90 s). The second step was performed on the CBD of five miniature pigs to understand more about the time-dependent changes in BBS development and the causes of adverse events. Using the conditions and techniques identified in the previous steps, the third step was conducted to create an optimal BBS model in 12 miniature pigs. In the first trial, four out of 10 animals died (40%) after the procedure due to cholangitis-induced sepsis. Based on this, biliary obstruction was prevented in further steps by placing a biliary plastic stent after RFA application. Histologic examinations over time showed that a severe abscess developed at the RFA application site on the fifth day, followed by fibrosis on the tenth day, and completion on the twentieth day. In the third trial, 11 animals survived (91.7%), the average BBS fibrotic wall thickness was 1107.9 µm (763.1–1864.6 µm), and the degree of upstream biliary dilation was 14.4 mm (11.05–20.7 mm). In conclusion, endobiliary RFA combined with a biliary plastic stent resulted in a safe and reproducible BBS animal model.

In Vivo Evaluation of a Novel Radiofrequency Ablation Electrode in Pig Livers

(1) Background: Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is an alternative treatment for pancreatic tumors. Currently, EUS-RFA has been trialled to treat hepatic tumors. However, little has been reported about optimal settings for EUS-RFA in patients with hepatic tumors. We evaluated the ablation effect after in vivo RFA using a new EUS-RFA electrode in a pig model. (2) Methods Four pigs were used for the in vivo test. The in vivo testing was divided into two tests based on the length of the RFA electrode (0.5, 0.7, 1 or 1.5 cm), the ablation power (30 W or 50 W), and the ablation time (10 or 15 s). In test one, ablation effect was evaluated based on the electrode length and power. In test two, ablation effect was assessed based on power and time. (3) Results: In test one, the ablation width and depth correlated with the length of the electrode and power (0.5 cm, 10 W, 10 s: width 0.46 cm, depth 0.65 cm vs. 1.5 cm, 75 W, 10 s: width 0.77 cm, depth 1.80 cm). In test two, ablation width and depth were similar when RFA was set at 1.5cm, 50 W, and 10 s or 1 cm, 30 W, and 15 s (0.65 cm, 1.14 cm vs. 0.65cm, 1.26 cm). (4) Conclusions: The relationship between electrode length, ablation power, and ablation time, and the resulting ablation effect in pig livers suggest that EUS-RFA produces effective ablation while minimizing thermal injury.

Comparison of Endoscopic Radiofrequency Ablation and Argon Plasma Coagulation in Patients with Gastric Low-Grade Intraepithelial Neoplasia: A Large-Scale Retrospective Study.

Background Gastric low-grade intraepithelial neoplasia (LGIN) is a precancerous lesion of gastric cancer. Endoscopic therapies represented by radiofrequency ablation (RFA) and argon plasma coagulation (APC) have been applied to treat gastric LGIN in recent years. However, no comparative study examining the effectiveness and safety profiles of RFA and APC has been reported. Methods A single-center, large-scale, retrospective study, including 73 and 50 patients treated with RFA and APC, respectively, was conducted in the First Medical Center of Chinese PLA General Hospital from October 2015 to October 2020, with a two-year follow-up. Effectiveness, complications, operative factors, and other data were assessed. Results At 2 years of follow-up, cure, relapse, recurrence, and progression rates were 90.4%, 9.6%, 9.6%, and 2.7% in the RFA group, respectively, versus 90%, 10%, 12%, and 4% in the APC group, respectively, with no statistically significant differences between the two groups (all p > 0.05). However, the mean lesion size was significantly larger in the RFA group (2.6 ± 1.0 cm) than in the APC group (1.5 ± 0.6 cm) (p < 0.001); there was also a significant difference in the composition ratio of large lesions between the two groups (p < 0.001). No serious postoperative complications showed in either group, and the abdominal pain was the most common symptom in the short term after surgery. Conclusions RFA and APC are both safe and effective destructive therapies for gastric LGIN. RFA is more suitable for flat and large lesions, while APC is more suitable for small lesions, especially those with slight local uplift or depression. An intraoperative submucosal injection is expected to be an effective method for relieving postoperative abdominal pain.

Endoscopic Ultrasound-Guided Radiofrequency Ablation

Endoscopic Ultrasound-Guided Radiofrequency Ablation

Efficacy of Endoscopic Radiofrequency Ablation for Treatment of Reflux Hypersensitivity: A Study Based on Rome IV Criteria.

Objective Effective therapies for reflux hypersensitivity are lacking. Endoscopic radiofrequency ablation may reduce the sensitivity of the distal esophagus through direct interference with nociceptors or vagal afferent fibers and thus may be useful in reflux hypersensitivity. The aim of this study is to assess the effectiveness and possible mechanisms of endoscopic radiofrequency ablation in reflux hypersensitivity patients. Methods Patients with reflux hypersensitivity who fulfilled the Rome IV criteria and who wished to receive further treatment were recruited. Endoscopic radiofrequency ablation was delivered to the gastroesophageal junction. Data were collected by questionnaire using a 6-point Likert scale. The primary outcome measure was effect on symptoms including heartburn, regurgitation, and chest pain. The secondary outcomes were degree of satisfaction, medication use, acid exposure time (AET), low esophageal sphincter (LES) pressure, and total reflux episodes. We also assessed positive cell density of transient receptor potential vanilloid type 1 receptor (TRPV1) and calcitonin gene-related peptide (CGRP), both of which are biomarkers of afferent fibers, in biopsies obtained from esophageal mucosa 0.5 cm-1 cm above the Z line. These scales will be administered at baseline, 3-month follow-up, 6-month follow-up, and 12-month follow-up. Results A total of 22 reflux hypersensitivity patients were enrolled (14 males, median age 50.0 years). A significant improvement in symptom scores (heartburn, regurgitation, and chest pain) was noted at 3 months, 6 months, and 12 months (P < 0.001). Satisfaction with life increased to 72.7% (16/22), 72.7% (16/22), and 68.2% (15/22) at 3, 6, and 12 mo, respectively, compared with baseline (P < 0.001). Nineteen patients reduced their medication use after treatment. Of these, 22.7% (5/22), 31.8% (7/22), and 40.9% (9/22) subjects stopped medication use at 3 mo, 6 mo, and 12 mo, respectively. No statistical differences were noted in AET, LES pressure, or total reflux episodes from preoperation to 12 mo postoperation. After treatment, the positive cell density of both TRPV1 and CGRP decreased significantly; however, only TRPV1 had a positive correlation with heartburn (r = 0.51, P = 0.03) and chest pain (r = 0.77, P < 0.01). Conclusion Endoscopic radiofrequency ablation was an effective and safe therapeutic option in reflux hypersensitivity patients. Further studies with large sample size are required to validate the role of radiofrequency in reflux hypersensitivity.

Clinical efficacy and prognostic risk factors of endoscopic radiofrequency ablation for gastric low-grade intraepithelial neoplasia.

BACKGROUNDThe use of radiofrequency ablation (RFA) has been reported in the treatment of gastric low-grade intraepithelial neoplasia (LGIN). However, its efficacy and prognostic risk factors have not been well analyzed.AIMTo explore the efficacy and prognostic risk factors of RFA for gastric LGIN in a large, long-term follow-up clinical study.METHODSThe clinical data of 271 consecutive cases from 198 patients who received RFA for treatment of gastric LGIN at the Chinese PLA General Hospital from October 2014 to October 2020 were reviewed in this retrospective study. Data on operative parameters, complications, and follow-up outcomes including curative rates were recorded and analyzed.RESULTSThe curative rates of endoscopic RFA for gastric LGIN at 3 mo, 6 mo, and 1-5 years after the operation were 93.3%, 92.8%, 91.5%, 90.3%, 88.5%, 85.7%, and 83.3%, respectively. Multivariate analyses revealed that Helicobacter pylori (H. pylori) infection and disease duration > 1 year had a significant effect on the curative rate (P < 0.001 and P = 0.013, respectively). None of patients had bleeding, perforation, infection, or other serious complications after RFA, and the main discomfort was postoperative abdominal pain.CONCLUSIONRFA was safe and effective for gastric LGIN during long-term follow-up. H. pylori infection and disease course > 1 year may be the main risk factors for relapse of LGIN after RFA.

Intraductal radiofrequency ablation therapy for eradication of intraductal residual lesions after endoscopic papillectomy for ampullary adenoma

Yamamoto et al. report a case of intraductal residual lesions after endoscopic papillectomy successfully treated with endoscopic radiofrequency ablation therapy. This report provides readers with images and videos of precise intraductal radiofrequency ablation therapy methods for safe and effective eradication of intraductal residual lesions.

Inoperable duodenal ampullary carcinoma: Can endoscopic radiofrequency ablation therapy be a promising palliative treatment in the future?

This Editorial refers to the article by M.X. Xia et al., p 587‐595 of this issue.