Optimizing endoscopic therapy for early esophageal neoplasia

Early esophageal cancer, malignant or premalignant tissue, is treated endoscopically with either resection or heat-based ablation (burning the upper layer of the esophagus). The aim of this thesis was to optimize endoscopic treatment of early esophageal cancer. In the first part of this thesis we evaluated if cold-based ablation (freezing the upper layer of the esophagus) is a suitable alternative to heat-based ablation for treatment of premalignant esophageal tissue. Both techniques ablate aberrant esophageal tissue superficially to restore to normal esophageal tissue. In this thesis we showed that freezing, using different devices and dosages, is technically feasible, effective and safe with the important advantage of less post-procedural pain. Since most studies were performed with small sample sizes, a large European study is currently being conducted to confirm the results. The second part focused on minimal invasive treatment for early esophageal cancer. We reported that endoscopic resection and freezing can safely be combined in one treatment session, so less treatment sessions would be required. Moreover, we showed that sentinel node navigated surgery is feasible and safe in patients with early esophageal cancer with a high risk of lymph node metastases, which might save patients from surgery in the future if they have no tumor positive sentinel nodes. Lastly, we showed that patients with head and neck cancer have an increased risk of esophageal cancer and that these patients therefore could benefit from esophageal surveillance to detect esophageal cancer at an early stage