Introduction

Radiofrequency Ablation is the gold standard for ablating neoplastic Barrett Esophagus (BE). Hybrid argon plasma coagulation (H-APC) is a novel technique involving submucosal fluid injection before Argon Plasma Coagulation. We aim to assess its efficacy, safety, and tolerability.

Aims & Methods

We prospectively enrolled patients undergoing H-APC ablation at 4 Italian Hospitals in a multicenter observational study. Included were patients with histopathologically confirmed LGD, HGD, or residual BE after endoscopic resection of visible lesions, and who had not undergone previous ablative treatment. Complete eradication of intestinal metaplasia (CE-IM) and dysplasia (CE-D) were confirmed by biopsy samples from the neo-epithelium. Pain and dysphagia scores within 7 days post-ablation were evaluated by phone by the local investigator.

Results

Among the 61 enrolled patients (mean age 61.05 years, 85.3% males, mean C length 0.52 cm, mean M length 2.36 cm), 45.9% (28/61) had prior endoscopic resection of visible lesions, with adenocarcinoma being the most common worst histology (48.3%). Of the 51 patients who completed treatment sessions until April 2024, all of them achieved complete eradication of intestinal metaplasia by April 2024, with an average of 1.51 (S.D 0.83) sessions. 92 hybrid-APC sessions were performed without major complications, except for one case of post-ablation electrocoagulation syndrome. Mean pain score was 1.38/10 (S.D 2.1), mean dysphagia score was 1.3/5 (S.D. 0.6).

Conclusion

The Hybrid-APC technique shows robust efficacy and safety, with good tolerability in achieving initial CE-D and CE-IM. Definitive evidence of its effectiveness awaits prospective randomized comparative trials.