Safety and long-term efficacy of hybrid-argon plasma coagulation for the treatment of Barrett's esophagus: An Australian pilot study (with video)

Abstract

Background: Five to ten percent of all patients undergoing radiofrequency ablation (RFA), which is the most established technique for Barrett's esophagus (BE) ablation-develop strictures. Hybrid-argon plasma coagulation (APC) combines APC with submucosal saline injection that was recently developed to tackle this problem. The aims of this pilot study were to evaluate the feasibility, tolerance, safety and long-term efficacy of hybrid-APC for the treatment of BE. Methods: Patients with histological proven BE were selected for hybrid-APC. Prior to APC thermal ablation the mucosa was lifted using a submucosal high-pressure water jet injection system (Erbejet 2; Erbe, Tuebingen, Germany). Short-term (< 48 hours) and long-term (> 48 hours) safety were evaluated. Efficacy of ablation was measured at 3, 6, 12 and 24 months at follow-up endoscopy by evidence of macroscopically complete resolution of BE mucosa and/or histologically complete resolution of intestinal metaplasia (CRIM). Results: Eleven patients were included in the study (average age, 68.2 years; male 72.7%). Eight patients (72.7%) were treatment naive, 9.1% (n = 1) had prior RFA and 18.2% (n = 2) had prior endoscopic mucosal resection. Two patients were excluded from the study. Nine patients (100%) had macroscopic remission and 88.9% (n = 8) had macroscopic remission and microscopic CRIM at 24 months after hybrid-APC ablation. No treatmentrelated stricture or other major complications were observed, 1 patient (11.1%) reported minor adverse effects. Conclusion: In this prospective pilot study, hybrid-APC appears safe, feasible and effective after 24 months, which has not been evaluated so far. Further large, multi-centre trials are warranted to confirm the present results.

Hybrid argon plasma coagulation in Barrett’s esophagus: a systematic review and meta-analysis

“…The study-level outcomes are summarized in Table 2. 29,30,[32][33][34][35][36] The overall pooled CR-IM rate for patients undergoing hybrid-APC was 90.8% (95% confidence interval [CI], 0.872-0.939; I 2 =0%) (Fig. 2A).…”

“…Seven studies were included in the final analysis. [29][30][31][32][33][34][35] The study selection process is summarized in Figure 1.…”

“…Four studies evaluated CR-IM three months after complete macroscopic ablation of BE. [29][30][31][32] Kashin et al 34 evaluated CR-IM at one and three months following macroscopic ablation, and Shimizu et al 35 lowing completion of therapy. The beginning of the follow-up period and timing of CR-IM evaluation were not specified in the study conducted by Linn et al 33 Only two studies specified a limit to the number of therapies before classification as a 'treatment failure' .…”

“…Prague classifications of pre-treatment Barrett's and hybrid-APC settings are presented in Table 1. 29,30,[32][33][34][35][36] The settings were comparable across all studies that reported detailed treatment settings.…”

“…Six single-arm observational studies were assessed for bias using the modified NOS for case series (Supplementary Table 1). 15,16,29,30,[32][33][34][35][36] Four studies were deemed 'moderate' quality 31,32,34,35 and two studies were deemed 'good' quality. 29,30 Four studies failed to specify how patients were selected for inclusion in their study and whether these patients were consecutively eligible.…”