CC BY-NC-ND 4.0 · Endosc Int Open 2025; 13: a25318227
DOI: 10.1055/a-2531-8227
Original article

Efficacy and safety of H-APC in Barrett's esophagus: Italian prospective multicenter study

1   Digestive Endoscopy Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy (Ringgold ID: RIN9268)
,
Roberta Maselli
2   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy (Ringgold ID: RIN437807)
1   Digestive Endoscopy Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy (Ringgold ID: RIN9268)
,
3   Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy (Ringgold ID: RIN18654)
,
Cristiano Spada
3   Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy (Ringgold ID: RIN18654)
,
Gianluca Andrisani
4   Digestive Endoscopy Unit, Campus Bio-Medico University Hospital, Roma, Italy (Ringgold ID: RIN220431)
,
Francesco Maria Di Matteo
4   Digestive Endoscopy Unit, Campus Bio-Medico University Hospital, Roma, Italy (Ringgold ID: RIN220431)
,
Antonella La Terra
5   Endoscopy Unit, Ospedale San Giovanni Bosco, Torino, Italy (Ringgold ID: RIN18698)
,
Franco Coppola
5   Endoscopy Unit, Ospedale San Giovanni Bosco, Torino, Italy (Ringgold ID: RIN18698)
,
1   Digestive Endoscopy Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy (Ringgold ID: RIN9268)
,
Roberto De Sire
1   Digestive Endoscopy Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy (Ringgold ID: RIN9268)
,
Ludovico Alfarone
1   Digestive Endoscopy Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy (Ringgold ID: RIN9268)
,
Maddalena Menini
1   Digestive Endoscopy Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy (Ringgold ID: RIN9268)
,
1   Digestive Endoscopy Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy (Ringgold ID: RIN9268)
,
Cesare Hassan
2   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy (Ringgold ID: RIN437807)
1   Digestive Endoscopy Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy (Ringgold ID: RIN9268)
,
Alessandro Repici
2   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy (Ringgold ID: RIN437807)
1   Digestive Endoscopy Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy (Ringgold ID: RIN9268)
› Institutsangaben
Clinical Trial: Registration number (trial ID): NCT05645679, Trial registry: ClinicalTrials.gov (http://www.clinicaltrials.gov/), Type of Study: Prospective Multi Center Study

Abstract

Background and study aims

Hybrid argon plasma coagulation (H-APC) is a novel technique for ablation of neoplastic Barrett's esophagus (BE), consisting in submucosal fluid injection and subsequent APC of visible BE. The aim of this study was to assess H-APC efficacy, safety, and tolerability.

Patients and methods

We prospectively included patients undergoing H-APC ablation at four Italian Hospitals from September 2022 to March 2024. Patients with BE C3M5 maximum extent, low- or high-grade dysplasia (LGD, HGD) or residual BE after endoscopic resection (ER) of visible lesions were included. Patients who had undergone previous ablative treatments were excluded. The primary endpoints were complete eradication of intestinal metaplasia (CE-IM) and dysplasia (CE-D). Secondary endpoints were safety in terms of major and minor adverse events (AEs) and tolerability, assessed using pain (0–10) and dysphagia (0–5) scores within 7 days post-ablation (NCT05645679).

Results

Among the 51 enrolled patients (mean circumferential 0.43 cm; standard deviation [SD] 0.72, mean maximum longitudinal 2.20 cm; SD 1.09) who completed treatment (80 H-APC sessions), 45.1% (23/51) had prior ER of visible lesions. All patients achieved both CE-IM and CE-D (51/51), requiring a mean of 1.51 sessions (SD 0.83). Only one case of fever and absolute dysphagia was observed (1/51; 1.96% AEs). Regarding tolerability, mean pain score was 1.3 (SD 1.99) whereas mean dysphagia score was 1.28 (SD 0.56).

Conclusions

The H-APC technique showed promising results in terms of effectiveness and safety with good tolerability in achieving initial CE-IM and CE-D in a selected population of BE patients.

Supplementary Material



Publikationsverlauf

Eingereicht: 09. Oktober 2024

Angenommen nach Revision: 16. Dezember 2024

Accepted Manuscript online:
03. Februar 2025

Artikel online veröffentlicht:
26. Februar 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Davide Massimi, Roberta Maselli, Silvia Pecere, Cristiano Spada, Gianluca Andrisani, Francesco Maria Di Matteo, Antonella La Terra, Franco Coppola, Antonio Capogreco, Roberto De Sire, Ludovico Alfarone, Maddalena Menini, Marco Spadaccini, Cesare Hassan, Alessandro Repici. Efficacy and safety of H-APC in Barrett's esophagus: Italian prospective multicenter study. Endosc Int Open 2025; 13: a25318227.
DOI: 10.1055/a-2531-8227
 
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