B0204 - Hybrid Argon Plasma Coagulation and Argon Plasma Coagulation in Barrett’s Esophagus: A Systematic Review and Meta-Analysis

Banreet S. Dhindsa, MD¹, Lovekirat Dhaliwal, MD², John Paul Gallagher, MD¹, Harlan Sayles, MS¹, Saurabh Chandan, MD³, Prasad G. Iyer, MD, FACG^4
1University of Nebraska Medical Center, Omaha, NE; ²Oschner LSU Health Shreveport, Shreveport, LA; ³CHI Health Creighton School of Medicine, Omaha, NE; ⁴Mayo Clinic, Rochester, MN

Introduction: Due to the increasing incidence of Esophageal adenocarcinoma, detection and treatment of Barrett’s esophagus (BE) is critical. Radio-frequency ablation is the current standard of care, however, it is expensive with high recurrence rates. Argon Plasma Coagulation (APC) is an alternative method but is associated with perforation, stricture formation, and buried glands. Hybrid APC (hAPC) is a novel technique that combines APC with submucosal injection for eradication of BE. This is the first systematic review and meta-analysis to evaluate the efficacy and safety of hAPC in the management of BE.

Methods: We performed a comprehensive literature search of major databases from inception to Nov 2021. The primary outcomes assessed were the clinical remission of intestinal metaplasia (CRIM) and clinical remission of dysplasia (CRD) of hAPC, high power APC (90W), and standard APC (30-75W). The secondary outcomes assessed were the overall adverse events, individual adverse events, and recurrence rates. Pooled estimates were calculated using random-effects models with 95% confidence interval (C.I.). The statistical analysis was done using STATA v 17.0 software (StataCorp, LLC College Station, TX).

Results: The analysis included 37 studies (9 studies for hAPC, 4 studies for high power APC, 24 studies for standard APC) with a total of 1314 (265 for hAPC, 164 for high power APC, 885 for standard APC) patients. The calculated pooled rate of CRIM for hAPC was slightly higher at 92.11% than high power APC and standard APC groups. The calculated pooled rate of CRD for hAPC was higher than standard APC group as well. The calculated pooled rate of adverse events for hAPC was lower than other modalities. Stricture formation was the most common adverse event in all 3 groups. Stricture rates were lower in hAPC than in other groups. The calculated pooled rate of recurrence rate of BE for hAPC was higher than high power APC group but lower than standard APC group. Low to substantial heterogeneity was noted in our meta-analysis.

Discussion: hAPC appears to be a safe and effective treatment modality for patients with Barrett’s esophagus with high clinical success rates and a low rate of adverse events. Further, prospective or randomized controlled trials are needed to validate our findings.




Disclosures:


Banreet S. Dhindsa, MD¹, Lovekirat Dhaliwal, MD², John Paul Gallagher, MD¹, Harlan Sayles, MS¹, Saurabh Chandan, MD³, Prasad G. Iyer, MD, FACG⁴. B0204 - Hybrid Argon Plasma Coagulation and Argon Plasma Coagulation in Barrett’s Esophagus: A Systematic Review and Meta-Analysis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.