RFA for Flat Type High-grade and Medium-grade Intraepithelial Squamous Neoplasia

Not Applicable

Terminated

Conditions: Esophageal Squamous Cell Neoplasia (ESCN)

Interventions: Device: Radiofrequency ablation

Registration Number: NCT02953418

Lead Sponsor: Medtronic - MITG

Brief Summary: Multicenter, prospective cohort clinical trial in greater China

Detailed Description: Not available

Recruitment & Eligibility

Status: TERMINATED

Sex: All

Target Recruitment: 34

Inclusion Criteria

Patient is 18-85 years of age
Patient has evidence of ESCN, within the last 3 months, patient demonstrated a new diagnosis or a reconfirmed diagnosis of squamous MGIN and/or HGIN of the esophagus
On endoscopic examination, subject has at least one USL that measures at least 3 cm in at least one dimension and greater than ¼ of the esophageal circumference and has MGIN or HGIN on biopsy, confirmed by central pathologist
All lesions in the esophagus are completely flat (Paris type 0-IIb), both on WLE and Lugol's chromoendoscopy
The maximum allowable linear length of "USL-bearing esophagus" is 12 cm
Baseline endoscopic ultrasound (EUS) (if applicable) shows no exclusionary findings for the trial
Computed Tomography )CT( scan of chest and upper third of the abdomen (if applicable) shows no exclusionary findings for the trial
Based on the judgment of the study endoscopist, the patient is eligible for treatment, follow-up endoscopy, and biopsy as required by the protocol
EMR or ESD occurred > 3 months before enrollment, patients may be eligible for the study if procedure was curative (negative margins and no risk of lymph node involvement) and the patient has no other findings concerning for cancer
The subject is willing to provide written, informed consent to participate in this clinical study and understands the responsibilities of trial participation

Exclusion Criteria

Patient has esophageal squamous cell carcinoma (ESCC)
Any non-flat (Paris type 0-I, 0-IIa, 0-IIc, 0-III) abnormalities anywhere in the esophagus
Any abnormalities under WLE, Lugol's chromoendoscopy or NBI that are suspicious for ESCC anywhere in the esophagus (e.g. 'pink sign' USL, defined as a color change after Lugol's staining: initially whitish yellow and pink 2-3 minutes later)
Any USL with MGIN or worse on biopsy outside the treatment area
Esophageal stricture preventing passage of a therapeutic endoscope
Prior endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) which occurred < 3 months before enrollment
Any esophageal dilation in the past 12 months
Any history of a non-squamous cell cancer of the esophagus, or any history of a squamous cell cancer of the esophagus (any stage)
Any previous ablative therapy within the esophagus (photodynamic therapy, multipolar electrical coagulation, argon plasma coagulation, laser treatment, or other) or any radiation therapy to the esophagus
Previous esophageal surgery, except fundoplication without complications (i.e., no slippage, dysphagia, etc.)
Evidence of esophageal varices detected within last 6 months or at initial RFA procedure
Patient has active reflux esophagitis grade C or D
Evidence of eosinophilic esophagitis on endoscopy and/or histology
Inner diameter of the esophagus measuring <18 mm
Report of uncontrolled coagulopathy with international normalized ratio (INR) > 2 or platelet count <75,000 platelets per µL (note: a complete blood count is not required for all subjects in this study)
Patient is using anti-thrombotic agents that cannot be discontinued 7 days before and after therapeutic sessions
Patient has an implantable pacing device (examples: automated implantable cardioverter defibrillator, neurostimulator, cardiac pacemaker) and has not received clearance for enrollment in this study by specialist responsible for the pacing device
Patient has life expectancy less than 5 years
Patient suffers from psychiatric or other illness and/or has a known history of unresolved drug or alcohol dependency that would limit ability to comprehend or follow instructions related to informed consent, post- treatment instructions, or follow-up guidelines
Patient is considered to be part of a vulnerable population (e.g. prisoners or those without sufficient mental capacity)
The subject has participated in an investigational drug or device research study within 30 days of enrollment that would interfere with this study
Patient is pregnant or has plans to become pregnant in the ensuing 12 months (confirmation of non-pregnant status in women of child-bearing age and ability required with urine or blood test to be eligible)

Study & Design

Study Type: INTERVENTIONAL

Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Radiofrequency ablation	Radiofrequency ablation	Step-wise endoscopic RFA with the Barrx™ Flex Radiofrequency Ablation System using will be performed in 3 month intervals up to 12 months.

Primary Outcome Measures

Name	Time	Method
Percentage of Subjects With Complete Response (CR)	12 month	The primary endpoint is the percentage of subjects with "complete response (CR)", defined as complete eradication of squamous histological abnormalities (MGIN or worse) within the treatment area (TA) at 12 months after the initial treatment session

Secondary Outcome Measures

Name	Time	Method
Complete Response Within the Treatment Area	3, 6 and 12 Month	Number of patients demonstrating complete response within the treatment area (TA), defined as detection of ESCC in biopsy or resection specimen at any time within the first 12 months.
Disease Progression Outside the Treatment Area	Initial, 3, 6, 9 and 12 month	Proportion of patients demonstrating MGIN or worse outside the TA during treatment phase or follow-up
Complete Response at Three Months	3 Months	Number of patients with a CR after primary RFA, defined as absence of MGIN or worse in any of the biopsies from the treatment area at the three months visit