Germany: Study on Hybrid Argon Plasma Coagulation (H-APC)

Hybrid argon plasma coagulation (H-APC) seems to have a similar overall outcome as radiofrequency ablation (RFA) in patients with neoplastic Barrett's esophagus (BE), suggests a recent study. Results, published in the American Journal of Gastroenterology, showed eradication rates of BE after endoscopic resection as well as recurrence rates to be similar to those associated with radiofrequency ablation.

The current therapy of neoplastic BE is comprised of endoscopic resection plus ablation, radiofrequency being the best-studied technique. Mate Knabe, Departments of Internal Medicine II, Sana Hospital, Offenbach, Germany, and colleagues aimed to systematically assess the efficacy and safety of a potential alternative, namely H-APC in the combined therapy of neoplastic BE (BE-N) in a prospective trial.

The trial, conducted across 9 European centers, included consecutive patients with neoplastic BE undergoing ablation after curative endoscopic resection (89.6%) or primarily. For complete eradication of (initial complete eradication of intestinal metaplasia [CE-IM]), by definition including BE-associated neoplasia, up to 5 ablation sessions were allowed.

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. This was 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 endpoints were the rate of recurrence-free cases (sustained CE-IM) documented by negative follow-up endoscopies with biopsies and immediate/delayed adverse events.

Key Findings

• One hundred fifty-four patients (133 men and 21 women, mean age 64 years) received a mean of 1.2 resections and 2.7 ablation sessions (range 1–5).
• Initial CE-IM was achieved in 87.2% of 148 cases in the PP analysis (ITT 88.4%); initial BE-associated neoplasia was 98.0%.
• On 2-year follow-up of the 129 successfully treated cases, 70.8% (PP) or 65.9% (ITT) showed sustained CE-IM; recurrences were mostly endoscopy-negative biopsy-proven BE epithelium and neoplasia in 3 cases.
• Adverse events were seen in 6.1%.

"Recurrence and eradication rates of Barrett's intestinal metaplasia and neoplasia through hybrid argon plasma coagulation at 2 years were found to be within expected ranges," wrote the authors.

"Final evidence in comparison to radiofrequency ablation can only be provided by a randomized comparative trial," they concluded.

Reference

Knabe, Mate MD^1,2,*; Beyna, Torsten MD³,*; Rösch, Thomas MD⁴; Bergman, Jacques MD⁵; Manner, Hendrik MD⁶; May, Andrea MD^1,7; Schachschal, Guido MD⁴; Neuhaus, Horst MD³; Kandler, Jennis MD^3,8; Weusten, Bas MD⁹; Pech, Oliver MD¹⁰; Faiss, Siegbert MD^11,12; Anders, Mario MD¹³; Vieth, Michael MD¹⁴; Sehner, Susanne MSc¹⁵; Bisschops, Raf MD¹⁶; Bhandari, Pradeep MD¹⁷; Ell, Christian MD¹; Ehlken, Hanno MD⁴ Hybrid APC in Combination With Resection for the Endoscopic Treatment of Neoplastic Barrett's Esophagus: A Prospective, Multicenter Study, The American Journal of Gastroenterology: November 30, 2021 - Volume - Issue - 10.14309/ajg.0000000000001539 doi: 10.14309/ajg.0000000000001539