Hybrid Argon-Plasma-Koagulation versus Radiofrequenzablation nach endoskopischer Resektion neoplastischer Läsionen im Barrettösophagus. Eine randomisierte Studie an einem tertiären Zentrum

Background/Aims: Endoscopic therapy for neoplastic Barrett’s esophagus (BE) has become the standard of care over the past two decades. In clinical practice, we regularly encounter patients who fail to achieve complete squamous epithelialization of the esophagus. Although the therapeutic strategies in the individual stages of BE, dysplasia, and esophageal adenocarcinoma are well studied and largely standardized, the problem of inadequate healing after endoscopic therapy is only marginally considered. This study aimed to shed light on the variables influencing inadequate wound healing after endoscopic therapy and the effect of bile acid sequestrants (BAS) on healing.Methods: Retrospective analysis of endoscopically treated neoplastic BE in a single referral center.Results: In 12.1% out of 627 patients, insufficient healing was present 8 to 12 weeks after previous endoscopic therapy. The average follow-up duration was 38.8±18.4 months. Complete healing was achieved in 13 patients already after intensifying proton pump inhibitor therapy. Out of 48 patients under BAS, 29 patients (60.4%) showed complete healing. An additional eight patients (16.7%) improved, but only partial healing was achieved. Eleven (22.9%) patients showed no response to BAS augmented therapy.Conclusions: In cases of insufficient healing even under exhaustion of proton pump inhibitors, treatment with BAS can be an option as an ultimate healing attempt.

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“…However, no significant differences were found between ablation methods in terms of insufficient healing. 16 , 21 …”

Section: Discussionmentioning

confidence: 99%

Bile acid sequestrants in poor healing after endoscopic therapy of Barrett’s esophagus

et al. 2023

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“…The pooled rate of stricture development with RFA has been reported as 5.6% (95% CI, 4.2% to 7.4%), 51 while that with cryotherapy has been reported as 7.3%. 50 In a study comparing ablation after endoscopic resection, Knabe et al 52 reported a stricture rate of 2% with hybrid APC compared to 13% with RFA. Thus, irrespective of the type of APC, the overall incidence of strictures with APC remains low compared to other ablative therapies.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Argon Plasma Coagulation for the Ablation of Barrett’s Esophagus: A Systemic Review and Meta-Analysis

Kozyk,

Kumar,

Strubchevska

et al. 2023

Gut and Liver

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Background/Aims Argon plasma coagulation (APC) is an alternate ablative method to radiofrequency ablation for the treatment of Barrett’s esophagus (BE), and it is preferred due to its lower cost and widespread availability. The present meta-analysis aimed to analyze the safety and efficacy of APC for the management of BE. Methods A literature search from January 2000 to November 2022 was done for studies analyzing the outcome of APC in BE. The primary outcomes were clearance rate of intestinal metaplasia and adverse events (AE). Pooled event rates were expressed with summative statistics. Results A total of 38 studies were included in the final analysis. The pooled event rate for clearance rate of intestinal metaplasia with APC in BE was 86.8% (95% confidence interval [CI], 83.5% to 90.2%), with high-power and hybrid APC having a higher rate compared to standard APC. The pooled incidence of AE with APC in BE was 22.5% (95% CI, 15.3% to 29.7%), without any significant difference between the subgroups, with self-limited chest pain being the commonest AE. The incidence of serious AE was only 0.4% (95% CI, 0.0% to 1.0%), while stricture development was seen only in 1.7% (95% CI, 0.9% to 2.6%) of cases. The pooled recurrence rate of BE was 16.1% (95% CI, 10.7% to 21.6%), with a significantly lower recurrence with high-power APC than standard APC. Conclusions High-power and hybrid APC seem to have an advantage over standard APC in terms of clearance rate and recurrence rate. Further studies are required to compare the efficacy and safety of hybrid APC with standard APC and radiofrequency ablation.

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Hybrid Argon-Plasma-Koagulation versus Radiofrequenzablation nach endoskopischer Resektion neoplastischer Läsionen im Barrettösophagus. Eine randomisierte Studie an einem tertiären Zentrum

Cited by 2 publications

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Bile acid sequestrants in poor healing after endoscopic therapy of Barrett’s esophagus

Bile acid sequestrants in poor healing after endoscopic therapy of Barrett’s esophagus

Efficacy and Safety of Argon Plasma Coagulation for the Ablation of Barrett’s Esophagus: A Systemic Review and Meta-Analysis

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