Kibria R, Akram S, Moezzi J, Ali S
Department of Gastroenterology, Dayton VA Medical Center, Wright State University, Dayton, OH, USA.
Acta Gastroenterol Belg. 2009 Jul-Sep;72(3):373-6.
Esophageal squamous papillomatosis (ESP) is a rare condition, occurring in an estimated 0.01-0.097% in data from upper gastrointestinal endoscopies and autopsy series. Chronic mucosal irritation and infection with human papilloma virus (HPV) are proposed etiologies. Heavy use of tobacco and alcohol are common associations. The premalignant potential of ESP has long been debated in literature. The clinical course is variable, ranging from spontaneous regression to the development of squamous cell carcinoma. Due to the paucity of reported cases, no generalized therapeutic or surveillance recommendations exist. Photodynamic therapy (PDT) has been successfully used to treat Barrett's esophagus as well as superficial adenocarcinoma. However, its safety and efficacy in treating ESP with dysplasia is lacking. Balloon-based radiofrequency ablation using the HALO90 Ablation System is designed to remove the diseased cells using controlled heat. In recent clinical trials, it has shown great promise in treating Barrett's esophagus with high-grade dysplasia. We report the first ever use of balloon-based radiofrequency ablation to treat ESP with dysplasia. Clinical symptoms resolved after the first therapy session, however, ablation therapy was terminated early because squamous cell carcinoma in-situ was detected on surveillance endoscopy prior to the fourth therapy session. Although we failed to treat type 4 ESP with high-grade dysplasia with balloon-based radiofrequency ablation therapy, we believe that it might play a role in treating other localized types of ESP.
食管鳞状乳头状瘤病（ESP）是一种罕见疾病，在上消化道内镜检查和尸检系列数据中，其发生率估计为0.01%-0.097%。慢性黏膜刺激和人乳头瘤病毒（HPV）感染是推测的病因。大量吸烟和饮酒是常见的相关因素。ESP的恶变潜能在文献中一直存在争议。其临床病程多变，从自发消退到发展为鳞状细胞癌。由于报告的病例较少，不存在普遍适用的治疗或监测建议。光动力疗法（PDT）已成功用于治疗巴雷特食管以及浅表腺癌。然而，其治疗伴有发育异常的ESP的安全性和有效性尚缺乏。使用HALO90消融系统的基于球囊的射频消融旨在利用可控热量去除病变细胞。在最近的临床试验中，它在治疗伴有高级别发育异常的巴雷特食管方面显示出巨大前景。我们报告了首次使用基于球囊的射频消融治疗伴有发育异常的ESP。首次治疗后临床症状缓解，然而，在第四次治疗前的监测内镜检查中发现原位鳞状细胞癌，因此消融治疗提前终止。尽管我们未能用基于球囊的射频消融疗法治疗伴有高级别发育异常的4型ESP，但我们认为它可能在治疗其他局限性类型的ESP中发挥作用。
