Endoscopy 2020; 52(S 01): S114-S115
DOI: 10.1055/s-0040-1704354
ESGE Days 2020 oral presentations
Saturday, April 25, 2020 08:30 – 10:30 Esophageal High-tech: Newtreatment modalities for the esophagus Liffey Meeting Room 2
© Georg Thieme Verlag KG Stuttgart · New York

ARGON PLASMA COAGULATION FOR BARRETT’S ESOPHAGUS WITH LOW-GRADE DYSPLASIA: RANDOMIZED TRIAL WITH LONG-TERM FOLLOW-UP EVALUATING THE IMPACT OF POWER SETTING AND PROTON PUMP INHIBITOR DOSE

E Wronska
1   Center of Postgraduate Medical Education, Department of Gastroenterology, Hepatology and Oncology, Warsaw, Poland
2   Maria Sklodowska-Curie Institute - Oncology Center, Department of Gastroenterological Oncology, Warsaw, Poland
,
M Polkowski
1   Center of Postgraduate Medical Education, Department of Gastroenterology, Hepatology and Oncology, Warsaw, Poland
2   Maria Sklodowska-Curie Institute - Oncology Center, Department of Gastroenterological Oncology, Warsaw, Poland
,
J Orlowska
2   Maria Sklodowska-Curie Institute - Oncology Center, Department of Gastroenterological Oncology, Warsaw, Poland
,
A Mroz
3   Center of Postgraduate Medical Education, Department of Pathomorphology, Warsaw, Poland
4   Maria Sklodowska-Curie Institute - Oncology Center, Department of Pathology and Laboratory Medicine, Warsaw, Poland
,
P Wieszczy
1   Center of Postgraduate Medical Education, Department of Gastroenterology, Hepatology and Oncology, Warsaw, Poland
5   Maria Sklodowska-Curie Institute - Oncology Center, Department of Cancer Prevention, Warsaw, Poland
,
J Regula
1   Center of Postgraduate Medical Education, Department of Gastroenterology, Hepatology and Oncology, Warsaw, Poland
2   Maria Sklodowska-Curie Institute - Oncology Center, Department of Gastroenterological Oncology, Warsaw, Poland
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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    Aims Variable results have been reported on the ablation of Barrett`s esophagus (BE) with argon plasma coagulation (APC) and the APC treatment protocol of BE has not been standardized. The aim of this randomized study was to evaluate the impact of power setting and post-ablation proton-pump inhibitor (PPI) dose on the efficacy and safety of APC for BE with low-grade dysplasia (LGD). The long-term outcomes of the treatment were also prospectively evaluated.

    Methods Seventy-one patients were randomly assigned to APC with power set at 90W or 60W followed by 120mg or 40mg omeprazole. The primary outcome was the rate of complete (endoscopic and histologic) ablation of BE at six weeks. Secondary outcomes included safety and long-term efficacy. Analysis was conducted on an intention-to-treat basis.

    Results Complete ablation of BE in the 90W/120mg, 90W/40mg, and 60W/120mg groups was confirmed in 18/23 (78%), 15/25 (60%), 17/23 (74%) patients at six weeks and in 16/23 (70%), 13/25 (52%), and 15/23 (65%) patients at two years post treatment (differences not significant). Twenty-eight patients required additional APC for residual (n=23) or recurrent (n=5) BE. At a median follow-up of 108 months 66/71 (93%) patients maintained complete ablation, without significant differences between study groups. No high-grade dysplasia or adenocarcinoma developed. The overall rate of adverse events (97% mild in severity) did not differ significantly between groups. Chest pain/discomfort was more frequent in patients treated with 90W vs. 60W (19/23 (83%), 17/25 (68%), and 9/23 (39%) patients in the 90W/120mg, 90W/40mg, and 60W/120mg groups, respectively; p< 0.001). One patient had esophageal perforation and two developed stenosis.

    Conclusions The APC power setting and PPI dose did not impact the efficacy and safety of BE ablation. Irrespective of treatment protocol complete ablation of BE with LGD was durable in over 90% of patients without an evidence of neoplasia progression in the long term.


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