Benefit, tolerance, and safety of hybrid argon plasma coagulation for treatment of Barrett's esophagus: US pilot study

Abstract

Background and study aims A novel technique for Barrett’s esophagus (BE) ablation, termed hybrid APC, has recently been developed. The aims of this US pilot study were to evaluate the efficacy, tolerance and safety of hybrid APC for the treatment of BE.

Patients and methods Patients with biopsy-proven BE referred to our tertiary care center over a 12-month period for mucosal ablation were eligible for this study. Efficacy of ablation was measured on follow-up endoscopy by demonstrating either a reduction of visible BE or biopsies proving complete resolution of intestinal metaplasia (CRIM). To evaluate tolerance and safety, patients were called on post-procedure days 1 and 7.

Results Twenty-two patients with BE (4.5 % intramucosal carcinoma, 31.8 % high-grade dysplasia, 18.1 % low-grade dysplasia, 36.3 % non-dysplastic, 9.1 % indefinite for dysplasia) underwent 40 treatments with hybrid APC. All patients had endoscopic improvement of BE disease and 19 of 22 patients (86.4 %) achieved CRIM. With regard to tolerance, average pain scores (0 to 10 scale) on follow-up were 2.65 and 0.62 on days 1 and 7, respectively. With regards to safety, there were two treatment-related strictures (9.1 %) that required a single balloon dilation.

Conclusions Hybrid APC appears to be promising in the treatment of BE. The ablation protocol used in this study demonstrated efficacy, tolerability, and a safety profile similar to radiofrequency ablation. Given the significant price difference between hybrid APC and other modalities for Barrett’s ablation, this modality may be more cost-effective. These results warrant further study in a large prospective multicenter trial.

Publikationsverlauf

Eingereicht: 25. November 2019

Angenommen: 29. Mai 2020

Artikel online veröffentlicht:
14. Dezember 2021

• References

• 1 Shaheen NJ, Sharma P, Overholt BF. et al. Radiofrequency ablation in Barrettʼs esophagus with dysplasia. N Engl J Med 2009; 360: 2277-2288
• 2 Singh T, Sanaka MR, Thota PN. Endoscopic therapy for Barrettʼs esophagus and early esophageal cancer: Where do we go from here?. World J Gastrointest Endosc 2018; 10: 165-174
• 3 Shaheen NJ, Overholt BF, Sampliner RE. et al. Durability of radiofrequency ablation in Barrettʼs esophagus with dysplasia. Gastroenterology 2011; 141: 460-468
• 4 Haidry RJ, Dunn JM, Butt MA. et al. Radiofrequency ablation and endoscopic mucosal resection for dysplastic barrettʼs esophagus and early esophageal adenocarcinoma: outcomes of the UK National Halo RFA Registry. Gastroenterology 2013; 145: 87-95
• 5 Strauss AC, Agoston AT, Dulai PS. et al. Radiofrequency ablation for Barrettʼs-associated intramucosal carcinoma: a multi-center follow-up study. Surg Endosc 2014; 28: 3366-3372
• 6 Tan MC, Kanthasamy KA, Yeh AG. et al. Factors associated with recurrence of Barrettʼs esophagus after radiofrequency ablation. Clin Gastroenterol Hepatol 2019; 17: 65-72
• 7 Manner H, May A, Miehlke S. et al. Ablation of nonneoplastic Barrettʼs mucosa using argon plasma coagulation with concomitant esomeprazole therapy (APBANEX): a prospective multicenter evaluation. Am J Gastroenterol 2006; 101: 1762-1769
• 8 Manner H, Neugebauer A, Scharpf M. et al. The tissue effect of argon-plasma coagulation with prior submucosal injection (Hybrid APC) versus standard APC: A randomized ex-vivo study. United European Gastroenterol J 2014; 2: 383-390
• 9 Norton ID, Wang L, Levine SA. et al. Efficacy of colonic submucosal saline solution injection for the reduction of iatrogenic thermal injury. Gastrointest Endosc 2002; 56: 95-99
• 10 Manner H, May A, Kouti IC. et al. Efficacy and safety of hybrid APC for the ablation of Barrettʼs esophagus. Surg Endosc 2016; 30: 1364-1370
• 11 Sharma P, Dent J, Armstrong D. et al. The development and validation of an endoscopic grading system for Barrettʼs esophagus: the Prague C & M criteria. Gastroenterology 2006; 131: 1392-1399
• 12 Manner H, May A, Miehlke S. et al. Ablation of nonneoplastic Barrettʼs mucosa using argon plasma coagulation with concomitant esomeprazole therapy (APBANEX): a prospective multicenter evaluation. Am J Gastroenterol 2006; 101: 1762-1769
• 13 Pereira-Lima JC, Busnello JV, Saul C. et al. High power setting argon plasma coagulation for the eradication of Barrettʼs esophagus. Am J Gastroenterol 2000; 95: 1661-1668
• 14 Schulz H, Miehlke S, Antos D. et al. Ablation of Barrettʼs epithelium by endoscopic argon plasma coagulation in combination with high-dose omeprazole. Gastrointest Endosc 2000; 51: 659-663