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Randomized Controlled Trial
. 2023 Oct;37(10):7803-7811.
doi: 10.1007/s00464-023-10313-5. Epub 2023 Aug 21.

Radiofrequency ablation versus hybrid argon plasma coagulation in Barrett's esophagus: a prospective randomised trial

Mate Knabe  1 , Jens Wetzka  2 , Lukas Welsch  3 , Johannes Richl  4 , Florian Michael  3 , Sandra Blößer  2 , Myriam Heilani  3 , Holger Kronsbein  5 , Andrea May  2
Affiliations
Randomized Controlled Trial

Radiofrequency ablation versus hybrid argon plasma coagulation in Barrett's esophagus: a prospective randomised trial

Mate Knabe et al. Surg Endosc. 2023 Oct.

Abstract

Introduction: Radiofrequency ablation (RFA) and hybrid argon plasma coagulation (H-APC) are established thermal ablation techniques for eradicating Barrett's esophagus after endoscopic resection. This study aimed to compare RFA with H-APC in relation to safety, effectiveness and eradication rates.

Methods: After endoscopic resection, patients were randomly assigned to H-APC or RFA. A simplified H-APC technique was applied at 60 W. RFA was used with a 90° focal catheter and a simplified protocol of 12 J/cm2 × 3 or with a Halo 360° balloon and 10 J/cm2/cleaning/10 J/cm2. Eradication rates and adverse events were recorded. Patients received follow-up examinations after 3, 6, 12 and 24 months.

Results: One hundred and one patients were finally included in the study (RFA N = 47, H-APC N = 54). The median follow-up period for short-term was 6.0 (CI 5.4-6.9) months and for long term 21 (CI 19.2.5-22.7) months. In total 211 ablations were performed. The eradication rates after long-term follow-up were 74.2% in the RFA group and 82.9% in the H-APC group. Post-interventional pain was significantly greater in the RFA group, with a mean score of 4.56/10 and duration of 7.54 days, in comparison with a mean score of 2.07/10 over 3.59 days in the H-APC group. Stenoses requiring intervention were noted in 3.7% of patients in the H-APC arm and 14.9% of those in the RFA arm.

Conclusions: Both ablation techniques have good results in relation to the eradication rate, with a slightly better outcome in the H-APC group. The severity and duration of pain were significantly greater in the RFA group.

Keywords: Barrett; Hybrid argon-plasma-coagulation; Radiofrequency ablation.

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Conflict of interest statement

Mate Knabe, Johannes Richl, Sandra Blößer, and Andrea May received funds for another study by Erbe Elektromedizin Tübingen, Germany. The present trial was investor initiated and was not funded by any company. Mate Knabe, Jens Wetzka, Lukas Welsch, Johannes Richl, Florian Michael, Sandra Blößer, Myriam Heilani, Holger Kronsbein, Andrea May have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
a Chromoendoscopy in combination with zoom endoscopy shows the margin of an early adenocarcinoma and non-neoplastic Barrett’s mucosa. b Hybrid-APC in a non-neoplastic Barrett at the 12 o’clock position. c RFA using a 90° focal catheter for ablation
Fig. 2
Fig. 2
The flow chart shows treatments and follow-up examinations after randomisation for all patients. BE Barrett’s eradication; H-APC hybrid argon plasma coagulation; RFA radiofrequency ablation
See this image and copyright information in PMC

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