Hybrid APC in Combination With Resection for the Endoscopic Treatment of Neoplastic Barrett's Esophagus: A Prospective, Multicenter Study

Knabe M, Beyna T, Rösch T, Bergman J, Manner H, May A, Schachschal G, Neuhaus H, Kandler J, Weusten B, Pech O, Faiss S, Anders M, Vieth M, Sehner S, Bisschops R, Bhandari P, Ell C, Ehlken H (2022)

Publication Type: Journal article

Publication year: 2022

Journal

American Journal of Gastroenterology Springer Nature

Book Volume: 117

Pages Range: 110-119

Journal Issue: 1

DOI: 10.14309/ajg.0000000000001539

Abstract

INTRODUCTION: The current therapy of neoplastic Barrett's esophagus (BE) consists of endoscopic resection plus ablation, with radiofrequency ablation as the best studied technique. This prospective trial assesses a potential alternative, namely hybrid argon plasma ablation. METHODS: Consecutive patients with neoplastic BE undergoing ablation after curative endoscopic resection (89.6%) or primarily were included into this prospective trial in 9 European centers. Up to 5 ablation sessions were allowed for complete eradication of BE (initial complete eradication of intestinal metaplasia [CE-IM]), by definition including BE-associated neoplasia, documented by 1 negative endoscopy with biopsies. The main outcome was the rate of initial CE-IM in intention-to-treat (ITT) and per-protocol (PP) samples at 2 years. The secondary end points were the rate of recurrence-free cases (sustained CE-IM) documented by negative follow-up endoscopies with biopsies and immediate/delayed adverse events. RESULTS: One hundred fifty-four patients (133 men and 21 women, mean age 64 years) received a mean of 1.2 resection and 2.7 ablation sessions (range 1-5). Initial CE-IM was achieved in 87.2%of 148 cases in the PP analysis (ITT88.4%); initialBE-associated neoplasiawas98.0%.On2-year follow-up of the129successfully treated cases, 70.8% (PP) or 65.9% (ITT) showed sustained CE-IM; recurrences were mostly endoscopynegative biopsy-proven BE epithelium and neoplasia in 3 cases. Adverse events were seen in 6.1%. DISCUSSION: Eradication and recurrence rates of Barrett's intestinal metaplasia and neoplasia by means of hybrid argon plasma coagulation at 2 years seemto be within expected ranges. Final evidence in comparison to radiofrequency ablation can only be provided by a randomized comparative trial.

Involved external institutions

Sana Kliniken AG DE Germany (DE) Evangelisches Krankenhaus Düsseldorf DE Germany (DE) Universitätsklinikum Hamburg-Eppendorf (UKE) DE Germany (DE) Amsterdam University Medical Centers (Amsterdam UMC) / Amsterdam Universitair Medische Centra NL Netherlands (NL) Sanofi-Aventis Groupe FR France (FR) Antonius Ziekenhuis Sneek NL Netherlands (NL) Krankenhaus Barmherzige Brüder DE Germany (DE) Asklepios Kliniken DE Germany (DE) Vivantes - Netzwerk für Gesundheit GmbH DE Germany (DE) Klinikum Bayreuth DE Germany (DE) University Hospital Leuven (UZ) / Universitaire ziekenhuizen Leuven BE Belgium (BE) Portsmouth Hospitals NHS Trust GB United Kingdom (GB)

How to cite

APA:

Knabe, M., Beyna, T., Rösch, T., Bergman, J., Manner, H., May, A.,... Ehlken, H. (2022). Hybrid APC in Combination With Resection for the Endoscopic Treatment of Neoplastic Barrett's Esophagus: A Prospective, Multicenter Study. American Journal of Gastroenterology, 117(1), 110-119. https://doi.org/10.14309/ajg.0000000000001539

MLA:

Knabe, Mate, et al. "Hybrid APC in Combination With Resection for the Endoscopic Treatment of Neoplastic Barrett's Esophagus: A Prospective, Multicenter Study." American Journal of Gastroenterology 117.1 (2022): 110-119.

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