Barrett’s Endoscopic Therapy Using Hybrid-Argon Plasma Coagulation Is Safe and Effective

Barrett’s Endoscopic Therapy Using Hybrid-Argon Plasma Coagulation Is Safe and Effective

Prateek Sharma, MD, FASGE, reviewing Knabe M, et al. Am J Gastroenterol 2021 Nov 30.

Endoscopic therapy for Barrett’s esophagus (BE) usually involves resection of visible lesions by endoscopic mucosal resection followed by mucosal ablation using radio frequency ablation. Hybrid argon plasma coagulation (H-APC) is a new mucosal ablation technique that uses a combination of submucosal lift of the BE tissue followed by APC ablation. 

This prospective, multicenter European study enrolled 154 patients (86% men; mean age, 64 years) with BE length ≤10 cm to evaluate the safety and efficacy of H-APC. Patients underwent endoscopic resection followed by H-APC (if there was a visible lesion) or H-APC alone for flat dysplastic BE. H-APC was performed every 6 to 12 weeks for up to 5 sessions before treatment was considered a failure. Once complete eradication of metaplasia or neoplasia was identified by negative endoscopy and histology, follow-up endoscopy was performed at 3, 6, 12, and 24 months with biopsy per Seattle protocol. 

After a mean of 1.2 resections and 2.7 H-APC sessions (range, 1-5), complete eradication of intestinal metaplasia rates were: 87.2% using intention-to-treat analysis and 88.4% using per-protocol analysis. Of 120 patients followed for 2 years, 102 were recurrence-free at 12 months, and 85 (65.9%) remained recurrence-free at 2 years. Rates of complication were 0.5% per H-APC treatment and 6.1% per patient; esophageal strictures were noted in 3.9% of the treated patients.

Prateek Sharma, MD, FASGE

COMMENT

Mucosal ablation of the flat BE mucosa using H-APC appears to be safe and effective at 2 years of follow-up. Complete eradication rates of intestinal metaplasia (complete BE eradication) appear to be consistent with published literature using other therapies; however, direct comparative study data are awaited.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Knabe M, Beyna T, Rösch T, et al. Hybrid APC in combination with resection for the endoscopic treatment of neoplastic Barrett’s esophagus: a prospective, multicenter study. Am J Gastroenterol 2021 Nov 30. (Epub ahead of print) (https://doi.org/10.14309/ajg.0000000000001539)

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