Efficacy, Tolerance, and Safety of Hybrid Argon Plasma Coagulation for the Treatment of Barrett’s Esophagus: A U.S. Pilot Study

Abstract

Introduction: A novel technique for Barrett’s esophagus (BE) ablation, termed hybrid argon plasma coagulation (APC), has recently been developed. This technique raises mucosa using a high-pressure water jet to achieve needleless submucosal injection. Hybrid ablation may reduce injury to the underlying submucosa, potentially decreasing rates of stricture formation and pain. Current literature on this method is limited. The aims of this pilot study were to evaluate the efficacy, tolerance and safety of Hybrid-APC for the treatment of BE. Methods: Patients with biopsy proven BE referred to our tertiary care center for mucosal ablation were recruited. Both treatment-naive and patients previously treated were included. Ablation was performed by 2 endoscopists using a standardized technique as follows: after APC marking of the Barrett’s segment, submucosal injection was performed followed by a first pass of APC ablation. Areas of coagulated tissue were then debrided using a distal attachment cap. Repeat submucosal injection followed by second pass ablation was then performed at a lower setting. Efficacy of ablation was measured on follow up endoscopy via reduced size of visible BE or biopsy-proven complete resolution of intestinal metaplasia (CRIM). Tolerance and safety were evaluated with patient calls on post-procedure days (PPD) 1 and 7. Results: A total of 25 patients underwent 38 HAPC treatments. Baseline characteristics included nondysplastic 76%, Indeterminate for dysplasia 12%, Low Grade Dysplasia 8%, High Grade Dysplasia 4% with average age of 68.0 years, 76% males, Prague C range of 0-6, and Prague M range of 0-8. History of previous treatments included RFA (44%), EMR (20%), cryotherapy (12%). 44% were treatment-naive. Average procedure time was 25 minutes. 16 of 25 patients (64%) underwent follow up endoscopy; all had endoscopic improvement of BE with a reduced average BE length (initial: Prague C=0.7, M=2.1; followup: Prague C=0.26, M=0.6; P=0.002). 9 out of 16 patients (56.3%) achieved CRIM. 6 patients (37.5%) reached CRIM after one hybrid APC treatment. Average pain scores (0 to 10 scale) was 3 on PPD 1 and 0.71 on PPD 7. The only complication was one treatment-related stricture which required a single balloon dilation (stricture rate 4.2%). Conclusion: Based on this pilot study, hybrid APC appears promising in the treatment of BE with a tolerability and a safety profile similar to radiofrequency ablation. These results warrant further study in a large multicenter trial.371_A Figure 1. Initial marking of target area371_B Figure 2. Complete ablation of Barrett’s esophagus tissue with APC following submucosal lift371_C Figure 3. Three-month followup EGD demonstrating resolution of Barrett’s esophagus, and no evidence of stricture formation.