Su1143 EFFICACY, TOLERANCE, AND SAFETY OF HYBRID ARGON PLASMA COAGULATION FOR THE TREATMENT OF BARRETT'S ESOPHAGUS: A SINGLE CENTER PILOT STUDY

Abstract

A novel technique for Barrett’s esophagus (BE) ablation, termed Hybrid APC, has recently been developed. Prior to APC ablation the mucosa is raised using a submucosal injection that is created using a needle-less system with a high pressure water jet. This has the potential to reduce injury to the underlying submucosa thus possibly decreasing rate of stricture formation. The current literature on this novel method is limited. The aims of this pilot study were to evaluate the efficacy, tolerance and safety of Hybrid-APC for the treatment of Barrett’s esophagus. Patients with biopsy proven BE referred to our tertiary care center for mucosal ablation were eligible for this study. Both treatment-naïve and patients previously treated were included. The procedure was performed by 2 endoscopists using a standardized technique as follows: after APC marking of the Barrett’s segment, submucosal injection of the tissue was performed followed by first pass of APC mucosal ablation. Areas of coagulated tissue were then debrided off using a distal attachment cap. Repeat submucosal injection followed by 2nd pass APC mucosal ablation was then performed at a lower dose. 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. A total of 17 patients with biopsy proven NDBE 58.8%, LGD 17.6%, HGD 23.5% underwent 24 treatments with Hybrid APC. Average age was 69.2 years, Male 83.3%, Prague C ranged 0-6 and Prague M ranged 0-8. 58.8% of patients had undergone prior RFA, 17.6% prior EMR, 11.7% prior cryotherapy and 35.3% were naive. The average procedure time was 20.64 minutes. With regards to efficacy, 8 of 17 had follow up endoscopy and all had endoscopic improvement of BE disease with the average length of BE at initial procedure Prague C 0.44 M 1.88 and at follow-up Prague C 0.13 M 0.4. The reduction in maximal extent of BE was statistically significant (P=0.0157). Four out of 8 patients achieved CRIM. 3 patients reached CRIM after one Hybrid APC treatment. With regards to tolerance, average pain scores (0 to 10 scale) on follow up day 1 was 2.39, and on day 7 was 0.42. With regards to safety, there was one treatment-related stricture which required a single balloon dilation (stricture rate 4.2%). There were no other early or late complications. According to this pilot study, Hybrid APC appears promising in the treatment of Barrett’s Esophagus. Our study demonstrated tolerability and a safety profile similar to radiofrequency ablation. These results warrant further study in a large multicenter trial.