HYBRID ARGON PLASMA COAGULATION IN THE TREATMENT OF BARRETT'S ESOPHAGUS: AN EXPERIMENT
DOI:
https://doi.org/10.32782/2226-2008-2025-1-4Keywords:
Barrett's esophagus, hiatal hernia, argon plasma coagulation, argon plasma ablation, Esophageal metaplasiaAbstract
Background. Barrett's esophagus (BE) is a precancerous condition marked by the transformation of squamous epithelium into columnar epithelium. Traditionally, radiofrequency ablation (RFA) has been the standard treatment, but newer methods like hybrid argon plasma coagulation (APC) and cryotherapy are emerging as alternatives. Aim. To compare the effects of various lifting fluids on the efficiency of performing hybrid APC in the treatment of BE. Methods. The experiment was conducted on pig esophagi. Various lifting fluids (0.9% sodium chloride, 4% gelatin, and 6% hydroxyethyl starch) were used. A gastroscope, an electrosurgical unit with an APC2 module, and endoscopic needles were employed. Pathological analyses were performed to assess the efficacy of the lifting fluids and compare hybrid APC to standard APC. Nine procedures were conducted, including classic APC and hybrid APC using different fluids and power settings. Results. Classic APC at 30 watts showed limited mucosal coagulation, while at 60 watts, full coagulation with significant submucosal damage was observed. Hybrid APC with colloid solutions provided longer lifting duration, reducing the need for reinjections. At 30 and 60 watts, hybrid APC preserved the submucosal and muscular layers, with complete mucosal coagulation at higher wattages. Conclusions. Hybrid APC offers an effective alternative to traditional methods for treating Barrett's esophagus, with fewer complications and increasing global adoption.
References
Shah SN, Chehade NEH, Tavangar A, et al. Hybrid argon plasma coagulation in Barrett's esophagus: a systematic review and meta-analysis. Clin Endosc. 2023;56(1):38-49. doi:10.5946/ce.2022.179
Tyvonchuk OS, Buryi OM, Babii ІV, Sanzharov OM. The optical-morphological diagnosis ratio in esophageal metaplasia. Ukr J Clin Surg. 2023;90(1):31-34. DOI: https://doi.org/10.26779/2786-832X.2023.1.31 (in Ukrainian).
Spadaccini M, Alfarone L, Chandrasekar VT, et al. What Is “Cold” and What Is “Hot” in Mucosal Ablation for Barrett’s Oesophagus-Related Dysplasia: A Practical Guide. Life. 2023; 13(4):1023. doi.org/10.3390/life13041023
Shimizu T, Samarasena JB, Fortinsky KJ, et al. Benefit, tolerance, and safety of hybrid argon plasma coagulation for treatment of Barrett's esophagus: US pilot study. Endosc Int Open. 2021 Dec 14;9(12):E1870-E1876. doi: 10.1055/a-1492-2450.
Kolb JM, Shah S, Chahine A, Chang K, Samarasena JB. Hybrid argon plasma coagulation for Barrett's esophagus. VideoGIE. 2021;6(8):339-341. Published 2021 Jun 10. doi:10.1016/j.vgie.2021.04.002
Knabe M, Beyna T, Rösch T, et al. Hybrid APC in Combination With Resection for the Endoscopic Treatment of Neoplastic Barrett's Esophagus: A Prospective, Multicenter Study. Am J Gastroenterol. 2022 Jan 1;117(1):110-119. doi: 10.14309/ajg.0000000000001539.
Manner H, Neugebauer A, Scharpf M, et al. The tissue effect of argon-plasma coagulation with prior submucosal injection (Hybrid-APC) versus standard APC: A randomized ex-vivo study. United European Gastroenterol J. 2014;2(5):383-390. doi:10.1177/2050640614544315
Qumseya BJ, Wani S, Desai M, et al. Adverse Events After Radiofrequency Ablation in Patients With Barrett's Esophagus: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2016;14(8):1086-1095.e6. doi:10.1016/j.cgh.2016.04.001
Pandey G, Mulla M, Lewis WG, Foliaki A, Chan DSY. Systematic review and meta-analysis of the effectiveness of radiofrequency ablation in low grade dysplastic Barrett's esophagus. Endoscopy. 2018;50(10):953-960. doi:10.1055/a-0588-5151
