Esophageal squamous papillomatosis with dysplasia. Is there a role of balloon-based radiofrequency ablation therapy?

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.