TY - JOUR
T1 - Hybrid APC in Combination With Resection for the Endoscopic Treatment of Neoplastic Barrett's Esophagus
T2 - A Prospective, Multicenter Study
AU - Knabe, Mate
AU - Beyna, Torsten
AU - Rösch, Thomas
AU - Bergman, Jacques
AU - Manner, Hendrik
AU - May, Andrea
AU - Schachschal, Guido
AU - Neuhaus, Horst
AU - Kandler, Jennis
AU - Weusten, Bas
AU - Pech, Oliver
AU - Faiss, Siegbert
AU - Anders, Mario
AU - Vieth, Michael
AU - Sehner, Susanne
AU - Bisschops, Raf
AU - Bhandari, Pradeep
AU - Ell, Christian
AU - Ehlken, Hanno
N1 - Funding Information: Financial support : Study was supported by Erbe Co, Tübingen, Germany. Publisher Copyright: © 2022 Wolters Kluwer Health. All rights reserved.
PY - 2022/1/1
Y1 - 2022/1/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85123118849&partnerID=8YFLogxK
U2 - https://doi.org/10.14309/ajg.0000000000001539
DO - https://doi.org/10.14309/ajg.0000000000001539
M3 - Article
C2 - 34845994
SN - 0002-9270
VL - 117
SP - 110
EP - 119
JO - American journal of gastroenterology
JF - American journal of gastroenterology
IS - 1
ER -