Common techniques for endoscopic non-excisional treatment include: radiofrequency ablation (RFA), photodynamic therapy (PDT), argon ion coagulation (APC), multipolar electrocoagulation (MPEC), laser therapy, thermal probe therapy, and cryotherapy.
Overall, complications from non-excisional treatment are relatively rare, and you can usually be discharged 2 to 3 days after treatment, or in some hospitals, on an outpatient basis, and go home the same day.
The relatively common complications include bleeding, perforation, stenosis, chest pain, painful swallowing, and photosensitivity reactions.
- Bleeding
Bleeding is the most common acute complication of radiofrequency ablation, often occurring within the first 24 hours after the procedure. You may spit up foamy sputum with blood or vomit large amounts of blood straight away.
If you only spit up foamy sputum, you can manage this by taking ice water, ice saline, or Yunnan Baiyao by mouth. If symptoms do not resolve, seek prompt medical attention. Inpatients can call the on-call physician directly.
If you are vomiting a lot of blood, you need to seek help from your family or call the emergency number yourself right away. Once you get to the hospital, your doctor can stop the bleeding with a gastroscope. A special reminder to remember: vomit blood, don’t swallow it.
- Perforation
There are intraoperative perforations and delayed perforations, with the latter requiring more vigilance.
If you develop a fever of more than 38.5°C and chest pain after eating after treatment, you should suspect a delayed perforation. At this point, you need to fast and abstain from food and water and contact your primary care physician promptly.
- Stenosis
Stenosis is the most common long-term adverse effect of radiofrequency ablation therapy, but the incidence is relatively low. If the lesion invades the entire circumference of the esophagus, then the probability of stricture after treatment is relatively high.
You may have varying degrees of difficulty swallowing, and in severe cases you may not even be able to drink water, at which point you need to be seen in the hospital. Your doctor can help relieve your symptoms with endoscopic esophageal dilation.
- Chest pain, swallowing pain
This is a relatively common condition, but it is usually not very serious and can be relieved on its own. Please keep in mind that do not eat hard, hot food after surgery to avoid mucosal damage. If the pain is severe, you can take oral pain medication to relieve it as prescribed by your doctor. If your temperature exceeds 38.5°C, or if your symptoms continue to worsen, please contact your primary care provider.
- Photosensitivity reaction
This is the main adverse reaction to photodynamic therapy. Prior to treatment, you will need to receive a photosensitizer injection, which may result in photosensitivity. Localized, temporary reactive edema may occur at the treatment site, inducing dysphagia, and may be accompanied by painful discomfort in the chest, back, or abdomen. In most cases, the symptoms are not too severe and are relatively short-lived and often resolve on their own.
If symptoms do not resolve, you can seek medical help to treat the symptoms with topical or oral medications. If there is a local allergy, topical hormonal medications can be used; if there is a secondary skin infection, topical antimicrobial preparations can be used; if there is a systemic allergy, oral antihistamines can be used, and in severe cases steroids can be added.
Co-written by:
Yuan Peng, Department of Gastrointestinal Oncology, Peking University Cancer Hospital