**4.9. RFA of esophageal neoplasm**

Yeh and Triadafilopoulos noted that a wide variety of endoscopic mucosal ablative techniques have been developed for early esophageal neoplasia. However, long-term control of neoplasic risk has not been demonstrated. The authors explained that most studies show that specialized intestinal metaplasia may persist underneath neo-squamous mucosa, posing a risk for subsequent neoplastic progression (41). Shaheen noted that the pathogenesis of BE is poorly understood. Given that some patients will have repeated bouts of severe erosive esophagitis and never develop BE, host factors must play an important role. The author stated that the utility of neoadjuvant radiation and chemotherapy in those with adenocarcinoma, although they are widely practiced, is not of clear benefit, and some authorities recommend against it. Ablative therapies, as well as endoscopic mucosal resection, hold promise for those with superficial cancer or high-grade dysplasia. The author noted that most series using these modalities feature relatively short follow-up; longer-term studies are needed to better ascertain the effectiveness of these treatments (38).

Pedrazzani et al evaluated the effectiveness of 90 W argon plasma coagulation (APC) for the ablation of BE that is considered to be the main risk factor for the development of esophageal adenocarcinoma. They found that high power setting APC showed to be safe. The effects persist at a mean follow-up period of 2 years with a comparable cost in term of complications with respect to standard power settings. The authors stated, however, that further studies with greater number of patients are required to confirm these results and to assess if ablation reduces the incidence of malignant progression (42). Hage et al stated that although endoscopic removal of BE by ablative therapies is possible in the majority of patients, histologically complete elimination can not be achieved in all cases. Persistent BE may still harbor molecular aberrations and must therefore be considered still to be at risk of progression to adenocarcinoma (43).
