Abstract
Mo1201 EFFICACY, TOLERANCE, AND SAFETY OF HYBRID ARGON PLASMA COAGULATION FOR THE TREATMENT OF BARRETT'S ESOPHAGUS: A U.S. PILOT STUDY
Gastrointestinal endoscopy, Vol.89(6 Supplement), pp.AB461-AB461
06/2019
DOI: 10.1016/j.gie.2019.03.739
Abstract
Background and Aims
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 step aims at reducing injury to the underlying submucosa caused by thermal energy and therefore possibly decreasing pain and the rate of stricture formation. The current literature on this novel method is limited and there remains to be a standardized technique. The aims of this US pilot study were to evaluate the efficacy, tolerance and safety of Hybrid-APC for the treatment of BE.
Patients and Methods
Patients with biopsy proven BE referred to our tertiary care center over a 12 month period for mucosal ablation were eligible for this study. Both treatment-naïve and patients previously treated with other modes of endoscopic eradication therapy were included. The procedures were performed by two expert endoscopists using a standardized technique. 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.
Results
22 patients with BE (4.5% Intramucosal CA, 31.8% High Grade Dysplasia, 18.1% LGD, 36.3%% non-dysplastic, 9.1% indefinite for dysplasia) underwent 39 treatments with Hybrid APC. Average age was 67.5 years, 86% were males. Prague C & M values respectively ranged from 0 to 6 and 1 to 8 with an average index C 0.73, M 1.99. 50% of patients had undergone prior RFA, 22.7% prior EMR, 13.6% prior cryotherapy, and 36.3% were treatment naive. The average index treatment time was 23.9 minutes. With regards to efficacy, over the study period 15 out of 22 (68%) patients achieved CRIM. 11 patients reached CRIM after one Hybrid APC treatment. All patients had endoscopic improvement of BE disease with an average length of BE at follow-up of C 0.21, M 0.63. With regards to tolerance, average pain scores (0 to 10 scale) on follow up were 2.65 and 0.62 at day 1 and 7 respectively. With regards to safety, there were two treatment-related strictures (9%) which required a single balloon dilation, one of which was in a patient who had a prior cryotherapy procedure. There were no other early or late complications.
Conclusions
Based on this US pilot study, Hybrid APC appears to be promising in the treatment of Barrett’s Esophagus. The ablation protocol used in this study demonstrated efficacy, tolerability and a safety profile similar to radiofrequency ablation. Given the significant price difference of Hybrid APC with other modalities for Barrett’s ablation, this modality may be more cost effective. These results warrant further study in a large prospective multicenter trial.
Details
- Title: Subtitle
- Mo1201 EFFICACY, TOLERANCE, AND SAFETY OF HYBRID ARGON PLASMA COAGULATION FOR THE TREATMENT OF BARRETT'S ESOPHAGUS: A U.S. PILOT STUDY
- Creators
- Toshitaka Shimizu - University of California, IrvineJason B. Samarasena - University of California, IrvineKyle J. Fortinsky - University of California, IrvineRintaro Hashimoto - University of California, IrvineAllen R. Yu - University of California, IrvineJames Y. Han - University of California, IrvineNabil E. Chehade - University of California, IrvineDavid Lee - University of California, IrvineKenneth J. Chang - University of California, Irvine
- Resource Type
- Abstract
- Publication Details
- Gastrointestinal endoscopy, Vol.89(6 Supplement), pp.AB461-AB461
- Publisher
- MOSBY-ELSEVIER
- DOI
- 10.1016/j.gie.2019.03.739
- ISSN
- 0016-5107
- eISSN
- 1097-6779
- Language
- English
- Date published
- 06/2019
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984696776302771
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