Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Hybrid argon plasma coagulation in Barrett's esophagus: a systematic review and meta-analysis

  • Sagar N. Shah (Department of Internal Medicine, Los Angeles Medical Center, University of California) ;
  • Nabil El Hage Chehade (Division of Internal Medicine, MetroHealth Medical Center, Case Western Reserve University) ;
  • Amirali Tavangar (H.H. Chao Comprehensive Digestive Disease Center and Division of Gastroenterology/Hepatology, University of California) ;
  • Alyssa Choi (H.H. Chao Comprehensive Digestive Disease Center and Division of Gastroenterology/Hepatology, University of California) ;
  • Marc Monachese (H.H. Chao Comprehensive Digestive Disease Center and Division of Gastroenterology/Hepatology, University of California) ;
  • Kenneth J. Chang (H.H. Chao Comprehensive Digestive Disease Center and Division of Gastroenterology/Hepatology, University of California) ;
  • Jason B. Samarasena (H.H. Chao Comprehensive Digestive Disease Center and Division of Gastroenterology/Hepatology, University of California)
  • Received : 2022.07.02
  • Accepted : 2022.08.01
  • Published : 2023.01.30
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Abstract

Background/Aims: Patients with Barrett's esophagus are at increased risk of developing esophageal adenocarcinoma. Endoscopic therapies aim to eradicate dysplastic and metaplastic tissues. Hybrid argon plasma coagulation (hybrid-APC) utilizes submucosal fluid injection to create a protective cushion prior to ablation that shields the submucosa from injury. We performed a pooled meta-analysis to evaluate the safety and efficacy of hybrid-APC. Methods: We conducted a systematic search of major electronic databases in April 2022. Studies that included patients with dysplastic and non-dysplastic Barrett's esophagus undergoing treatment with hybrid-APC were eligible for inclusion. Outcome measures included complete remission of intestinal metaplasia (CR-IM), stricture formation, serious adverse events, and number of sessions necessary to achieve CR-IM. Results: Overall pooled CR-IM rate for patients undergoing hybrid-APC was 90.8% (95% confidence interval [CI], 0.872-0.939; I2=0%). Pooled stricture rate was 2.0% (95% CI, 0.005-0.042; I2=0%). Overall serious adverse event rate was 2.7% (95% CI, 0.007-0.055; I2=0%). Conclusions: Results of the current meta-analysis suggest that hybrid-APC is associated with high rates of CR-IM and a favorable safety profile. Interpretation of these results is limited by the inclusion of retrospective cohort and case series data. Randomized controlled trials that standardize treatment and outcome evaluation protocols are necessary to understand how this treatment option is comparable to the current standards of care.

Keywords

References

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