The role of argon plasma coagulation in the management of Barrett's esophagus: a single-center experience

Abstract

Background/aim: Patients with Barrett's esophagus (BE) are 30 times more likely to develop esophageal adenocarcinoma (EAC) than the general population. Data regarding the use of argon plasma coagulation (APC) for treatment of patients with BE in Egypt are still limited. This article discusses the efficacy and safety of APC as a thermoablative modality in Egyptian patients with BE. Materials and methods: A total of 73 referred eligible patients with a confirmed endoscopic and histopathologic diagnosis of BE were enrolled in this study and subjected to thermoablation by high-power (hp)-APC equipment at a 60 W setting until complete ablation or a maximum of five sessions and were followed up clinically and endoscopically at 3-month intervals. Computergenerated randomization allocated patients into APC-treated and control groups (n = 75), all of whom were treated with a proton pump inhibitor. Results: Minor and major complications occurred in 8 of 73 (10.95%) and 1 of 73 (1.36%) patients, respectively. Macroscopic ablation was achieved after one session in 37 of 73 (50.63%) patients, and complete histologic ablation was confirmed after 167 sessions in 69 of 73 (94.52%) patients. At 1-year follow-up, no relapses of BE or progression to EAC were observed. Conclusion: hp-APC at a medium-energy setting of 60 W in an acid-reduced environment can ablate BE effectively and safely with promising initial results.

Risk of recurrence of Barrett’s esophagus after successful endoscopic therapy

“…Among the 41 included studies, the primary endoscopic treatment modality was RFA in 21 studies, 9,12,14,15,18,21,22,27,29,30,32,39-41,43,47,49,51,53,54 APC in 7 studies, 33,34,36,45,46,48,52 EMR in 7 studies, 20,21,31,37,42,44,50 PDT in 2 studies, 7,19 multipolar electrocoagulation in 2 studies, 13,28 laser in 1 study, 35 and cryotherapy in 1 study. 38 Twenty-three studies were from North America, 9,12,14,15,18-20,22,27,30,32,35,37-39,41-44,47,53,54 15 studies were from Europe, 7,13,21,31,33,34,40,45,46,48-52 and 1 study each was from South America, 28 Africa, 36 and the Asia-Pacific. 29 Four studies included NDBE patients only, 13,28,34,52 and 16 studies included only DBE ± early neoplasia patients, 7,19-21,29,31,37,39,40,42,44,49,51,53,54 with the remainder including NDBE and DBE patients.…”

“…15,27,30 When all endoscopic modalities were included, 9 studies were deemed high quality, 9,12,18,32,37,39,42,49,54 22 studies were deemed medium quality, 7,13,14,19-22,28,29,31,34,35,40,41,43,44,47,50,51,53 and 10 studies were deemed low quality. 15,27,30,33,36,38,45,46,48,52 …”