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.

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Mo1201 EFFICACY, TOLERANCE, AND SAFETY OF HYBRID ARGON PLASMA COAGULATION FOR THE TREATMENT OF BARRETT'S ESOPHAGUS: A U.S. PILOT STUDY

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2019.03.739 ◽

2019 ◽

Vol 89 (6) ◽

pp. AB461

Author(s):

Toshitaka Shimizu ◽

Jason B. Samarasena ◽

Kyle J. Fortinsky ◽

Rintaro Hashimoto ◽

Allen R. Yu ◽

...

Keyword(s):

Pilot Study ◽

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Argon Plasma Coagulation ◽

Argon Plasma ◽

Plasma Coagulation

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Clinical pathways and outcomes of patients with Barrett’s esophagus in tertiary care settings: a prospective longitudinal cohort study in Australia, 2008–2016

Diseases of the Esophagus ◽

10.1093/dote/doaa119 ◽

2020 ◽

Author(s):

Renhua Na ◽

Kyoko Miura ◽

Suzanne O’Brien ◽

Guy D Eslick ◽

Bradley J Kendall ◽

...

Keyword(s):

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Clinical Pathways ◽

Tertiary Care ◽

Incidence Rates ◽

Segment Length ◽

Low Grade ◽

Adjusted Incidence ◽

Prospective Longitudinal

Summary Background Clinical services for Barrett’s esophagus have been rising worldwide including Australia, but little is known of the long-term outcomes of such patients. Retrospective studies using data at baseline are prone to both selection and misclassification bias. We investigated the clinical characteristics and outcomes of Barrett’s esophagus patients in a prospective cohort. Methods We recruited patients diagnosed with Barrett’s esophagus in tertiary settings across Australia between 2008 and 2016. We compared baseline and follow-up epidemiological and clinical data between Barrett’s patients with and without dysplasia. We calculated age-adjusted incidence rates and estimated minimally and fully adjusted hazard ratios (HR) to identify those clinical factors related to disease progression. Results The cohort comprised 268 patients with Barrett’s esophagus (median follow-up 5 years). At recruitment, 224 (84%) had no dysplasia, 44 (16%) had low-grade or indefinite dysplasia (LGD/IND). The age-adjusted incidence of esophageal adenocarcinoma (EAC) was 0.5% per year in LGD/IND compared with 0.1% per year in those with no dysplasia. Risk of progression to high-grade dysplasia/EAC was associated with prior LGD/IND (fully adjusted HR 6.55, 95% confidence interval [CI] 1.96–21.8) but not long-segment disease (HR 1.03, 95%CI 0.29–3.58). Conclusions These prospective data suggest presence of dysplasia is a stronger predictor of progression to cancer than segment length in patients with Barrett’s esophagus.

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Endoscopic Therapy of Esophageal Premalignancy and Early Malignancy

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2011.0073 ◽

2011 ◽

Vol 9 (8) ◽

pp. 890-899 ◽

Cited By ~ 8

Author(s):

Thomas B. Nealis ◽

Kay Washington ◽

Rajesh N. Keswani

Keyword(s):

Radiofrequency Ablation ◽

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Endoscopic Therapy ◽

Argon Plasma Coagulation ◽

Argon Plasma ◽

Ablation Techniques ◽

Attractive Alternative ◽

Low Grade ◽

Ablative Techniques

Esophageal adenocarcinoma (EAC) is an often deadly cancer with a rising incidence in Western countries. Chronic gastroesophageal reflux disease is associated with the metaplastic transformation of normal squamous epithelium to premalignant specialized intestinal metaplasia within the esophagus (Barrett's esophagus). Barrett's esophagus may progress to low-grade dysplasia (LGD), high-grade dysplasia (HGD), or even EAC. Although nondysplastic Barrett's esophagus progresses to EAC at a rate of 0.5% per year, rates of progression for true LGD and HGD are significantly higher. Treatment is mandatory for HGD and may be appropriate in select patients with nondysplastic Barrett's esophagus and many with LGD. Thus, accurate pathologic assessment is necessary before considering endoscopic therapy. Previously, only esophagectomy was offered to patients with HGD or EAC. However, esophagectomy has significant morbidity and mortality, and therefore endoscopic therapies have been advocated for early Barrett's neoplasia. These methods include endoscopic mucosal resection (EMR) and ablative techniques. Ablation techniques include argon plasma coagulation, multipolar electrocoagulation, laser therapy, photodynamic therapy, radiofrequency ablation, and cryotherapy. Of these, radiofrequency ablation has experienced the greatest adoption for the treatment of dysplastic Barrett's esophagus because of excellent published outcomes. The use of EMR to resect suspicious areas or raised lesions is mandatory to provide histology. In contrast, ablation techniques such as radiofrequency ablation have been shown to effectively eradicate large areas of dysplastic tissue with relative ease but do not allow for histologic assessment of the treated area. Combination EMR with radiofrequency ablation is thus advocated to resect visible lesions via EMR (providing histology) and ablate the remainder of the Barrett's esophagus. As always, the appropriate treatment is best determined after careful discussion with patients in a multidisciplinary environment. However, endoscopic therapy offers an attractive alternative to esophagectomy for early Barrett's neoplasia.

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