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Massimi D, Maselli R, Pecere S, Spada C, Andrisani G, Di Matteo FM, La Terra A, Coppola F, Capogreco A, De Sire R, Alfarone L, Menini M, Spadaccini M, Hassan C, Repici A. Efficacy and safety of H-APC in Barrett's esophagus: Italian prospective multicenter study. Endosc Int Open 2025; 13:a25318227. [PMID: 40018075 PMCID: PMC11866041 DOI: 10.1055/a-2531-8227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Accepted: 12/16/2024] [Indexed: 03/01/2025] Open
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.
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Affiliation(s)
- Davide Massimi
- Digestive Endoscopy Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Roberta Maselli
- Digestive Endoscopy Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Silvia Pecere
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Cristiano Spada
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Gianluca Andrisani
- Digestive Endoscopy Unit, Campus Bio-Medico University Hospital, Roma, Italy
| | | | | | - Franco Coppola
- Endoscopy Unit, Ospedale San Giovanni Bosco, Torino, Italy
| | - Antonio Capogreco
- Digestive Endoscopy Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Roberto De Sire
- Digestive Endoscopy Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Ludovico Alfarone
- Digestive Endoscopy Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Maddalena Menini
- Digestive Endoscopy Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Marco Spadaccini
- Digestive Endoscopy Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Cesare Hassan
- Digestive Endoscopy Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
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Wang D, Chen Y, Ji F, Hu JW, Zhou PH, Xu SC, Chen Y, Ye LP, Ye GL, Li R, Li ZS. Hybrid argon plasma coagulation for the treatment of Barrett's esophagus: A prospective, multicenter study. World J Clin Cases 2024; 12:3866-3872. [PMID: 38994274 PMCID: PMC11235429 DOI: 10.12998/wjcc.v12.i19.3866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/09/2024] [Accepted: 05/20/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND The incidence of Barrett's esophagus (BE) in China is lower compared to the Western populations. Hence, studies conducted in the Chinese population has been limited. The current treatment options available for BE treatment includes argon plasma coagulation (APC), radiofrequency ablation and cryoablation, all with varying degrees of success. AIM To determine the efficacy and safety of HybridAPC in the treatment of BE. METHODS The study cohort consisted of patients with BE who underwent HybridAPC ablation treatment. These procedures were performed by seven endoscopists from different tertiary hospitals. The duration of the procedure, curative rate, complications and recurrent rate by 1-year follow-up were recorded. RESULTS Eighty individuals were enrolled for treatment from July 2017 to June 2020, comprising of 39 males and 41 females with a median age of 54 years (range, 30 to 83 years). The technical success rate of HybridAPC was 100% and the overall curative rate was 98.15%. No severe complications occurred during the operation. BE cases were classified as short-segment BE and long-segment BE. Patients with short-segment BE were all considered cured without complications. Thirty-six patients completed the one-year follow-up without recurrence. Twenty-four percent had mild dysplasia which were all resolved with one post-procedural treatment. The mean duration of the procedure was 10.94 ± 6.52 min. CONCLUSION Treatment of BE with HybridAPC was found to be a simple and quick procedure that is safe and effective during the short-term follow-up, especially in cases of short-segment BE. This technique could be considered as a feasible alternative ablation therapy for BE.
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Affiliation(s)
- Dong Wang
- Department of Gastroenterology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - Yan Chen
- Department of Gastroenterology, Changhai Hospital, Shanghai 200438, China
| | - Feng Ji
- Department of Gastroenterology, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou 311399, Zhejiang Province, China
| | - Jian-Wei Hu
- Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ping-Hong Zhou
- Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Shu-Chang Xu
- Endoscopy Center, Tongji Hospital of Tongji University, Shanghai 200092, China
| | - Ying Chen
- Endoscopy Center, Tongji Hospital of Tongji University, Shanghai 200092, China
| | - Li-Ping Ye
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Taizhou 318001, Zhejiang Province, China
| | - Guo-Liang Ye
- Department of Gastroenterology, The Affiliated Hospital of Medicine School, Ningbo University, Ningbo 315021, Zhejiang Province, China
| | - Rui Li
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Changhai Hospital, Shanghai 200438, China
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Kozyk M, Kumar L, Strubchevska K, Trivedi M, Wasvary M, Giri S. Efficacy and Safety of Argon Plasma Coagulation for the Ablation of Barrett's Esophagus: A Systemic Review and Meta-Analysis. Gut Liver 2024; 18:434-443. [PMID: 37800316 PMCID: PMC11096916 DOI: 10.5009/gnl230094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/11/2023] [Accepted: 05/26/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND/AIMS Argon plasma coagulation (APC) is an alternate ablative method to radiofrequency ablation for the treatment of Barrett's esophagus (BE), and it is preferred due to its lower cost and widespread availability. The present meta-analysis aimed to analyze the safety and efficacy of APC for the management of BE. METHODS A literature search from January 2000 to November 2022 was done for studies analyzing the outcome of APC in BE. The primary outcomes were clearance rate of intestinal metaplasia and adverse events (AE). Pooled event rates were expressed with summative statistics. RESULTS A total of 38 studies were included in the final analysis. The pooled event rate for clearance rate of intestinal metaplasia with APC in BE was 86.8% (95% confidence interval [CI], 83.5% to 90.2%), with high-power and hybrid APC having a higher rate compared to standard APC. The pooled incidence of AE with APC in BE was 22.5% (95% CI, 15.3% to 29.7%), without any significant difference between the subgroups, with self-limited chest pain being the commonest AE. The incidence of serious AE was only 0.4% (95% CI, 0.0% to 1.0%), while stricture development was seen only in 1.7% (95% CI, 0.9% to 2.6%) of cases. The pooled recurrence rate of BE was 16.1% (95% CI, 10.7% to 21.6%), with a significantly lower recurrence with high-power APC than standard APC. CONCLUSIONS High-power and hybrid APC seem to have an advantage over standard APC in terms of clearance rate and recurrence rate. Further studies are required to compare the efficacy and safety of hybrid APC with standard APC and radiofrequency ablation.
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Affiliation(s)
- Marko Kozyk
- Department of Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | - Lohith Kumar
- Department of Gastroenterology, Nizam’s Institute of Medical Sciences, Hyderabad, India
| | - Kateryna Strubchevska
- Department of Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | - Manan Trivedi
- Department of General Surgery, KB Bhabha Hospital, Mumbai, India
| | | | - Suprabhat Giri
- Department of Gastroenterology, Nizam’s Institute of Medical Sciences, Hyderabad, India
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Zhang Q, Li M, Jin X, Zhou R, Ying Y, Wu X, Jing J, Pan W. Comparison of interventions for Barrett's esophagus: A network meta-analysis. PLoS One 2024; 19:e0302204. [PMID: 38709808 PMCID: PMC11073690 DOI: 10.1371/journal.pone.0302204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 03/30/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Barrett's esophagus (BE) is a precancerous condition that has the potential to develop into esophageal cancer (EC). Currently, there is a wide range of management options available for individuals at different pathological stages in Barrett's esophagus (BE). However, there is currently a lack of knowledge regarding their comparative efficacy. To address this gap, we conducted a network meta-analysis of published randomized controlled trials to examine the comparative effectiveness of all regimens. METHODS Data extracted from eligible randomized controlled trials were utilized in a Bayesian network meta-analysis to examine the relative effectiveness of BE's treatment regimens and determine their ranking in terms of efficacy. The ranking probability for each regimen was assessed using the surfaces under cumulative ranking values. The outcomes under investigation were complete ablation of BE, neoplastic progression of BE, and complete eradication of dysplasia. RESULTS We identified twenty-three RCT studies with a total of 1675 participants, and ten different interventions. Regarding complete ablation of non-dysplastic BE, the comparative effectiveness ranking indicated that argon plasma coagulation (APC) was the most effective regimen, with the highest SUCRA value, while surveillance and PPI/H2RA were found to be the least efficacious regimens. For complete ablation of BE with low-grade dysplasia, high-grade dysplasia, or esophageal cancer, photodynamic therapy (PDT) had the highest SUCRA value of 94.1%, indicating it as the best regimen. Additionally, for complete eradication of dysplasia, SUCRA plots showed a trend in ranking PDT as the highest with a SUCRA value of 91.2%. Finally, for neoplastic progression, radiofrequency ablation (RFA) and surgery were found to perform significantly better than surveillance. The risk of bias assessment revealed that 6 studies had an overall high risk of bias. However, meta-regression with risk of bias as a covariate did not indicate any influence on the model. In terms of the Confidence in Network Meta-Analysis evaluation, a high level of confidence was found for all treatment comparisons. CONCLUSION Endoscopic surveillance alone or PPI/H2RA alone may not be sufficient for managing BE, even in cases of non-dysplastic BE. However, APC has shown excellent efficacy in treating non-dysplastic BE. For cases of BE with low-grade dysplasia, high-grade dysplasia, or esophageal cancer, PDT may be the optimal intervention as it can induce regression of BE metaplasia and prevent future progression of BE to dysplasia and EC.
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Affiliation(s)
- Qinlin Zhang
- Department of Gastroenterology, Sanmen County People’s Hospital, Taizhou, Zhejiang, China
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Miya Li
- Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xin Jin
- Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ruhong Zhou
- Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yize Ying
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Xueping Wu
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jiyong Jing
- Department of Gastroenterology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Wensheng Pan
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Department of Gastroenterology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
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Palma García JM, Honrubia López R, Fernández de Castro C, Comas Redondo C. Hybrid-APC treatment for gastric vascular ectasia of an atypical location after failed radiofrequency ablation. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024; 116:289-290. [PMID: 37314122 DOI: 10.17235/reed.2023.9709/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A 76-year-old woman was being followed up for chronic anemia secondary to bleeding from vascular ectasias at the gastric antrum and the cardial and subcardial region. On several occasions the patient required fulguration of these lesions with conventional APC, which resulted in no clear improvement. Radiofrequency ablation of these lesions was then attempted using a 90-degree probe, which was successful on antral angiodysplasias but failed to remove lesions in the cardial and subcardial region since anatomy there prevented proper apposition of the probe onto the target mucosa. Given the absence of any improvement, it was decided to use fulguration for angiectasias at the cardial and subcardial level by means of Hybrid-APC, which consists of lifting the mucosa with an injection through the APC probe and then fulgurating in the pulsedAPC® mode, thus achieving a broader ablation area in a shorter time. During the subsequent review a clear reduction of vascular ectasias was observed.
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Knabe M, Wetzka J, Welsch L, Richl J, Michael F, Blößer S, Heilani M, Kronsbein H, May A. Radiofrequency ablation versus hybrid argon plasma coagulation in Barrett's esophagus: a prospective randomised trial. Surg Endosc 2023; 37:7803-7811. [PMID: 37605011 PMCID: PMC10520130 DOI: 10.1007/s00464-023-10313-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 07/15/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION Radiofrequency ablation (RFA) and hybrid argon plasma coagulation (H-APC) are established thermal ablation techniques for eradicating Barrett's esophagus after endoscopic resection. This study aimed to compare RFA with H-APC in relation to safety, effectiveness and eradication rates. METHODS After endoscopic resection, patients were randomly assigned to H-APC or RFA. A simplified H-APC technique was applied at 60 W. RFA was used with a 90° focal catheter and a simplified protocol of 12 J/cm2 × 3 or with a Halo 360° balloon and 10 J/cm2/cleaning/10 J/cm2. Eradication rates and adverse events were recorded. Patients received follow-up examinations after 3, 6, 12 and 24 months. RESULTS One hundred and one patients were finally included in the study (RFA N = 47, H-APC N = 54). The median follow-up period for short-term was 6.0 (CI 5.4-6.9) months and for long term 21 (CI 19.2.5-22.7) months. In total 211 ablations were performed. The eradication rates after long-term follow-up were 74.2% in the RFA group and 82.9% in the H-APC group. Post-interventional pain was significantly greater in the RFA group, with a mean score of 4.56/10 and duration of 7.54 days, in comparison with a mean score of 2.07/10 over 3.59 days in the H-APC group. Stenoses requiring intervention were noted in 3.7% of patients in the H-APC arm and 14.9% of those in the RFA arm. CONCLUSIONS Both ablation techniques have good results in relation to the eradication rate, with a slightly better outcome in the H-APC group. The severity and duration of pain were significantly greater in the RFA group.
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Affiliation(s)
- Mate Knabe
- Department of Gastroenterology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany.
| | - Jens Wetzka
- Department of Medicine I, Asklepios Paulinen Klinik Wiesbaden, Wiesbaden, Germany
| | - Lukas Welsch
- Department of Gastroenterology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Johannes Richl
- Department of Gastroenterology, Sana Klinikum GmbH Offenbach, Offenbach, Germany
| | - Florian Michael
- Department of Gastroenterology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Sandra Blößer
- Department of Medicine I, Asklepios Paulinen Klinik Wiesbaden, Wiesbaden, Germany
| | - Myriam Heilani
- Department of Gastroenterology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Holger Kronsbein
- Department of Gastroenterology, Facility Bielefeld-Bethel, University Hospital Ostwestfalen-Lippe, Bielefeld, Germany
| | - Andrea May
- Department of Medicine I, Asklepios Paulinen Klinik Wiesbaden, Wiesbaden, Germany
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Eusebi LH, Telese A, Castellana C, Engin RM, Norton B, Papaefthymiou A, Zagari RM, Haidry R. Endoscopic Management of Dysplastic Barrett's Oesophagus and Early Oesophageal Adenocarcinoma. Cancers (Basel) 2023; 15:4776. [PMID: 37835470 PMCID: PMC10571849 DOI: 10.3390/cancers15194776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
Barrett's oesophagus is a pathological condition whereby the normal oesophageal squamous mucosa is replaced by specialised, intestinal-type metaplasia, which is strongly linked to chronic gastro-oesophageal reflux. A correct endoscopic and histological diagnosis is pivotal in the management of Barrett's oesophagus to identify patients who are at high risk of progression to neoplasia. The presence and grade of dysplasia and the characteristics of visible lesions within the mucosa of Barrett's oesophagus are both important to guide the most appropriate endoscopic therapy. In this review, we provide an overview on the management of Barrett's oesophagus, with a particular focus on recent advances in the diagnosis and recommendations for endoscopic therapy to reduce the risk of developing oesophageal adenocarcinoma.
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Affiliation(s)
- Leonardo Henry Eusebi
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.C.); (R.M.E.)
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy;
| | - Andrea Telese
- Digestive Disease and Surgery Institute Cleveland Clinic, London SW1X 7HY, UK; (A.T.); (B.N.)
- Division of Surgery and Interventional Science, University College London, London NW1 2BU, UK
| | - Chiara Castellana
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.C.); (R.M.E.)
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy;
| | - Rengin Melis Engin
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.C.); (R.M.E.)
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy;
| | - Benjamin Norton
- Digestive Disease and Surgery Institute Cleveland Clinic, London SW1X 7HY, UK; (A.T.); (B.N.)
- Department of Gastroenterology, University College London Hospital (UCLH), London NW1 2BU, UK;
- Centre for Obesity Research, Department of Medicine, Rayne Institute, University College London, London NW1 2BU, UK
| | - Apostolis Papaefthymiou
- Department of Gastroenterology, University College London Hospital (UCLH), London NW1 2BU, UK;
| | - Rocco Maurizio Zagari
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy;
- Esophagus and Stomach Organic Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Rehan Haidry
- Digestive Disease and Surgery Institute Cleveland Clinic, London SW1X 7HY, UK; (A.T.); (B.N.)
- Division of Surgery and Interventional Science, University College London, London NW1 2BU, UK
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Spadaccini M, Alfarone L, Chandrasekar VT, Maselli R, Capogreco A, Franchellucci G, Massimi D, Fugazza A, Colombo M, Carrara S, Facciorusso A, Bhandari P, Sharma P, Hassan C, Repici A. What Is "Cold" and What Is "Hot" in Mucosal Ablation for Barrett's Oesophagus-Related Dysplasia: A Practical Guide. Life (Basel) 2023; 13:1023. [PMID: 37109552 PMCID: PMC10142767 DOI: 10.3390/life13041023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/31/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Over the last two decades, endoscopic eradication therapy has been established as the therapeutic strategy of choice for patients with Barrett's oesophagus-related dysplasia and early oesophageal adenocarcinoma. With a multimodal approach, ablative therapies have been highly effective in achieving remarkable eradication rates of metaplastic epithelium with an acceptable adverse event rate. Among ablative techniques, radiofrequency ablation is currently considered as the first-line option as its efficacy and safety are strongly supported by relevant data. Nevertheless, radiofrequency ablation is costly, and not universally available, or applicable to every situation. Moreover, primary failure and recurrence rates are not negligible. In the last few years, cryotherapy techniques and hybrid argon plasma coagulation have been increasingly assessed as potential novel ablative therapies. Preliminary data have been promising and suggest that they may even have a role as first-line options, alternatively to radiofrequency ablation. The aim of this review is to provide a practical guide for the ablation of Barrett's oesophagus, with emphasis on the different ablative options.
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Affiliation(s)
- Marco Spadaccini
- Department of Biomedical Sciences, Humanitas University, 20089 Rozzano, Italy
- Digestive Endoscopy Unit, Department of Endoscopy, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089 Rozzano, Italy
| | - Ludovico Alfarone
- Department of Biomedical Sciences, Humanitas University, 20089 Rozzano, Italy
- Digestive Endoscopy Unit, Department of Endoscopy, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089 Rozzano, Italy
| | | | - Roberta Maselli
- Department of Biomedical Sciences, Humanitas University, 20089 Rozzano, Italy
- Digestive Endoscopy Unit, Department of Endoscopy, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089 Rozzano, Italy
| | - Antonio Capogreco
- Digestive Endoscopy Unit, Department of Endoscopy, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089 Rozzano, Italy
| | - Gianluca Franchellucci
- Department of Biomedical Sciences, Humanitas University, 20089 Rozzano, Italy
- Digestive Endoscopy Unit, Department of Endoscopy, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089 Rozzano, Italy
| | - Davide Massimi
- Digestive Endoscopy Unit, Department of Endoscopy, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089 Rozzano, Italy
| | - Alessandro Fugazza
- Digestive Endoscopy Unit, Department of Endoscopy, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089 Rozzano, Italy
| | - Matteo Colombo
- Digestive Endoscopy Unit, Department of Endoscopy, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089 Rozzano, Italy
| | - Silvia Carrara
- Digestive Endoscopy Unit, Department of Endoscopy, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089 Rozzano, Italy
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Pradeep Bhandari
- Department of Gastroenterology, Portsmouth Hospitals University NHS Trust, Portsmouth PO6 3LY, UK
| | - Prateek Sharma
- Department of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO 66045, USA
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, 20089 Rozzano, Italy
- Digestive Endoscopy Unit, Department of Endoscopy, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089 Rozzano, Italy
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, 20089 Rozzano, Italy
- Digestive Endoscopy Unit, Department of Endoscopy, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089 Rozzano, Italy
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Estevinho MM, Pinho R, Silva JC, Correia J, Mesquita P, Freitas T. Hybrid Argon Plasma Coagulation for Barrett's Esophagus and for Colonic Mucosal Resection-A Systematic Review and Meta-Analysis. Biomedicines 2023; 11:biomedicines11041139. [PMID: 37189757 DOI: 10.3390/biomedicines11041139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023] Open
Abstract
Hybrid argon plasma coagulation (hAPC) is a novel technique that combines conventional argon plasma coagulation and waterjet submucosal expansion. The aims of this metanalysis were to evaluate the efficacy and safety of hAPC in the setting of Barret's esophagus (BE) ablation and as an adjunct to colonic endoscopic mucosal resection (EMR). Four electronic databases were searched, and the results were analyzed by two independent authors. Random-effects meta-analyses of the proportions of endoscopic and histologic remission (for BE), recurrence, and post-procedure adverse events were performed using R. Studies' reporting quality was also assessed. From the 979 identified records, 13 studies were included (10 regarding BE and three colonic EMR). The pooled percentages of endoscopic and histologic remission after hAPC for BE were 95% (95% confidence interval [CI] 91-99, I2 = 34) and 90% (95%CI 84-95, I2 = 46), respectively, while major adverse events and recurrence were registered in 2% (95%CI 0-5, I2 = 41) and 11% (95%CI 2-27, I2 = 11), respectively. Concerning hAPC-assisted EMR, the pooled percentages of major adverse events and recurrence were 5% (95%CI 2-10, I2 = 0) and 1% (95%CI 0-3, I2 = 40). Evidence suggests that the main advantages of hAPC are the increase in safety in the setting of BE ablation and the reduction of local recurrence after colonic EMR. Trials comparing hAPC with standard strategies are required to support its use for these indications.
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Affiliation(s)
- Maria Manuela Estevinho
- Department of Gastroenterology, Vila Nova de Gaia Espinho Hospital Center, 4400-129 Vila Nova de Gaia, Portugal
- Unit of Pharmacology and Therapeutics, Department of Biomedicine, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Rolando Pinho
- Department of Gastroenterology, Vila Nova de Gaia Espinho Hospital Center, 4400-129 Vila Nova de Gaia, Portugal
| | - João Carlos Silva
- Department of Gastroenterology, Vila Nova de Gaia Espinho Hospital Center, 4400-129 Vila Nova de Gaia, Portugal
| | - João Correia
- Department of Gastroenterology, Vila Nova de Gaia Espinho Hospital Center, 4400-129 Vila Nova de Gaia, Portugal
| | - Pedro Mesquita
- Department of Gastroenterology, Vila Nova de Gaia Espinho Hospital Center, 4400-129 Vila Nova de Gaia, Portugal
| | - Teresa Freitas
- Department of Gastroenterology, Vila Nova de Gaia Espinho Hospital Center, 4400-129 Vila Nova de Gaia, Portugal
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10
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Mueller J, Kayser G, Kuellmer A, Schiemer M, Bettinger D, Offensperger F, Thimme R, Schmidt A. ArgoCap - feasibility and safety of a novel over-the-scope device to facilitate endoscopic APC treatment. MINIM INVASIV THER 2023:1-9. [PMID: 36825622 DOI: 10.1080/13645706.2023.2180322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
INTRODUCTION Argon plasma coagulation (APC) is an electrosurgical procedure used, among other indications, for treatment of dysplastic Barrett's mucosa. Homogeneous and safe application can be compromised by varying distances and suboptimal angle of the probe to the tissue. In this study, we present ArgoCap, a novel endoscopic device developed to facilitate endoluminal APC treatment. Objectives of this preclinical study were to assess feasibility and safety and to determine suitable APC settings. MATERIAL AND METHODS One-hundred and thirty-two APC treatments of predefined areas using various APC settings were performed ex vivo in the opened porcine esophagus. Depth of thermal injury was assessed histologically. Feasibility of APC treatment in different locations was examined in 20 explanted porcine esophagi and in first in vivo porcine applications. RESULTS APC treatment in all quadrants of the esophagus was feasible. Histologically, thermal effects involving the whole thickness of the mucosa were visible with all settings. APC with pulsed mode resulted in deep thermal damage with all power settings. No lesions of the muscular layer occurred using precise (E8, E9) and forced (10 W, 20 W) mode. CONCLUSIONS Esophageal APC using ArgoCap is feasible and safe. The device has the potential to improve APC treatment of larger mucosal areas.
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Affiliation(s)
- Julius Mueller
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Gian Kayser
- Department of Pathology, University of Freiburg, Freiburg, Germany
| | - Armin Kuellmer
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Moritz Schiemer
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Dominik Bettinger
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Florian Offensperger
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Robert Thimme
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Arthur Schmidt
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
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11
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Keckstein JS, Keckstein S, Brunecker K, Neugebauer A, Nüssle D, Hoffmann S, Andress J, Neis F, Scharpf M, Enderle M, Rothmund R, Brucker SY, Jun MW, Kraemer B. Hybrid argon plasma coagulation (HybridAPC) versus sharp excision for the treatment of endometriosis: a prospective randomized clinical trial. Arch Gynecol Obstet 2023; 307:187-194. [PMID: 35284956 PMCID: PMC9837017 DOI: 10.1007/s00404-022-06473-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/16/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Endometriosis is a benign, but potentially serious gynaecological condition in terms of abdominal pain and impaired fertility. Laparoscopic excision techniques are considered the therapeutic standard. HybridAPC is presented as a novel technique for the non-contact thermal ablation of peritoneal endometriosis with simultaneous protection of the underlying thermosensitive structures by creating a needle-free elevated fluid cushion which enables a safer exposure and distance, as well as potentially improved peritoneal conditioning prior to APC. METHODS In this prospective randomized clinical trial, 39 patients with 132 superficial endometriotic lesions in total were treated with HybridAPC or sharp excision in an initial laparoscopic procedure according to randomization. In a second-look laparoscopy, adhesion formation was rated macroscopically. Histologic samples were taken from previously treated areas for evaluation of eradication rate. RESULTS The eradication rate was not significantly different between HybridAPC treatment and sharp excision (65 vs. 81%, p = .55). Adhesions formed in 5% of HybridAPC-treated lesions and in 10% after sharp excision (p = .49). HybridAPC treatment was significantly faster than sharp excision (69 vs. 106 s, p < .05). No intra- and postoperative complications were registered. CONCLUSION This clinical trial demonstrates the feasibility of this novel surgical technique with a promising impact on adhesion prevention. Compared to sharp excision, HybridAPC is likely to be a safe, tissue-preserving, and fast method for the treatment of peritoneal endometriosis.
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Affiliation(s)
- Julia S Keckstein
- Department of Women's Health, Tuebingen University Hospital, Calwerstr. 7, 72076, Tübingen, Germany.
- Department of Obstetrics and Gynecology, Klinikum Starnberg, Oßwaldstr. 1, 82319, Starnberg, Germany.
| | - Simon Keckstein
- Department of Women's Health, Tuebingen University Hospital, Calwerstr. 7, 72076, Tübingen, Germany
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Kristin Brunecker
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072, Tübingen, Germany
| | | | - Daniela Nüssle
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072, Tübingen, Germany
| | - Sascha Hoffmann
- Department of Women's Health, Tuebingen University Hospital, Calwerstr. 7, 72076, Tübingen, Germany
| | - Jürgen Andress
- Department of Women's Health, Tuebingen University Hospital, Calwerstr. 7, 72076, Tübingen, Germany
| | - Felix Neis
- Department of Women's Health, Tuebingen University Hospital, Calwerstr. 7, 72076, Tübingen, Germany
| | - Marcus Scharpf
- Department of Women's Health, Tuebingen University Hospital, Calwerstr. 7, 72076, Tübingen, Germany
| | - Markus Enderle
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072, Tübingen, Germany
| | - Ralf Rothmund
- Department of Women's Health, Tuebingen University Hospital, Calwerstr. 7, 72076, Tübingen, Germany
- Praxis Im Frauenzentrum Lindenhofspital, 3012, Bern, Switzerland
| | - Sara Y Brucker
- Department of Women's Health, Tuebingen University Hospital, Calwerstr. 7, 72076, Tübingen, Germany
| | - Martin Weiss Jun
- Department of Women's Health, Tuebingen University Hospital, Calwerstr. 7, 72076, Tübingen, Germany
| | - Bernhard Kraemer
- Department of Women's Health, Tuebingen University Hospital, Calwerstr. 7, 72076, Tübingen, Germany
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12
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Shah SN, Chehade NEH, Tavangar A, Choi A, Monachese M, Chang KJ, Samarasena JB. Hybrid argon plasma coagulation in Barrett's esophagus: a systematic review and meta-analysis. Clin Endosc 2023; 56:38-49. [PMID: 36733989 PMCID: PMC9902689 DOI: 10.5946/ce.2022.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 08/01/2022] [Indexed: 01/31/2023] Open
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%). CONCLUSION 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.
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Affiliation(s)
- Sagar N. Shah
- Department of Internal Medicine, Los Angeles Medical Center, University of California, Los Angeles, CA, USA
| | - Nabil El Hage Chehade
- Division of Internal Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Amirali Tavangar
- H.H. Chao Comprehensive Digestive Disease Center and Division of Gastroenterology/Hepatology, University of California, Irvine, CA, USA
| | - Alyssa Choi
- H.H. Chao Comprehensive Digestive Disease Center and Division of Gastroenterology/Hepatology, University of California, Irvine, CA, USA
| | - Marc Monachese
- H.H. Chao Comprehensive Digestive Disease Center and Division of Gastroenterology/Hepatology, University of California, Irvine, CA, USA
| | - Kenneth J. Chang
- H.H. Chao Comprehensive Digestive Disease Center and Division of Gastroenterology/Hepatology, University of California, Irvine, CA, USA
| | - Jason B. Samarasena
- H.H. Chao Comprehensive Digestive Disease Center and Division of Gastroenterology/Hepatology, University of California, Irvine, CA, USA,Correspondence: Jason B. Samarasena H.H. Chao Comprehensive Digestive Disease Center and Division of Gastroenterology/Hepatology, University of California, Irvine 333 City Blvd West Suite 400, Orange, CA 92868, USA E-mail:
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13
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Vantanasiri K, Iyer PG. State-of-the-art management of dysplastic Barrett's esophagus. Gastroenterol Rep (Oxf) 2022; 10:goac068. [PMID: 36381221 PMCID: PMC9651477 DOI: 10.1093/gastro/goac068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 08/15/2023] Open
Abstract
Endoscopic eradication therapy (EET) has become a standard of care for treatment of dysplastic Barrett's esophagus (BE) and early Barrett's neoplasia. EET mainly consists of removal of any visible lesions via endoscopic resection and eradication of all remaining Barrett's mucosa using endoscopic ablation. Endoscopic mucosal resection and endoscopic submucosal dissection are the two available resection techniques. After complete resection of all visible lesions, it is crucial to perform endoscopic ablation to ensure complete eradication of the remaining Barrett's segment. Endoscopic ablation can be done either with thermal techniques, including radiofrequency ablation and argon plasma coagulation, or cryotherapy techniques. The primary end point of EET is achieving complete remission of intestinal metaplasia (CRIM) to decrease the risk of dysplastic recurrence after successful EET. After CRIM is achieved, a standardized endoscopic surveillance protocol needs to be implemented for early detection of BE recurrence.
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Affiliation(s)
- Kornpong Vantanasiri
- Barrett’s Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Prasad G Iyer
- Barrett’s Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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14
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Razzak FA, Mahmoud T, Ghazi R, Abboud DM, Abu Dayyeh BK. Argon plasma coagulation prior to endoscopic sleeve gastroplasty for weight loss. VideoGIE 2022; 7:445-447. [DOI: 10.1016/j.vgie.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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15
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Paiji C, Sedarat A. Endoscopic Management of Esophageal Cancer. Cancers (Basel) 2022; 14:cancers14153583. [PMID: 35892840 PMCID: PMC9329770 DOI: 10.3390/cancers14153583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 02/04/2023] Open
Abstract
Advances in technology and improved understanding of the pathobiology of esophageal cancer have allowed endoscopy to serve a growing role in the management of this disease. Precursor lesions can be detected using enhanced diagnostic modalities and eradicated with ablation therapy. Furthermore, evolution in endoscopic resection has provided larger specimens for improved diagnostic accuracy and offer potential for cure of early esophageal cancer. In patients with advanced esophageal cancer, endoluminal therapy can improve symptom burden and provide therapeutic options for complications such as leaks, perforations, and fistulas. The purpose of this review article is to highlight the role of endoscopy in the diagnosis, treatment, and palliation of esophageal cancer.
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16
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Endoscopic Management of Barrett's Esophagus. Dig Dis Sci 2022; 67:1469-1479. [PMID: 35226224 DOI: 10.1007/s10620-022-07395-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 12/09/2022]
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17
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Tontini GE, Dioscoridi L, Rimondi A, Cantù P, Cavallaro F, Giannetti A, Elli L, Pastorelli L, Pugliese F, Mutignani M, Vecchi M. [Not Available]. Endosc Int Open 2022; 10:E386-E393. [PMID: 35528218 PMCID: PMC9068277 DOI: 10.1055/a-1781-7066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 09/21/2021] [Indexed: 01/28/2023] Open
Abstract
Objectives and study aims
Recent pilot studies have assessed the feasibility of a novel 1.9-/1.5-μm dual emission endoscopic laser treatment (
1.9-/1.5-μm
DEELT) for endoscopic hemostasis, ablation and resection. In this study, we investigated the safety and efficacy of
1.9-/1.5-μm
DEELT in patients with chronic anemia due to gastrointestinal vascular lesions in a real-life multicenter cohort setting.
Patients and methods
Consecutive patients with moderate/severe iron-deficiency anemia undergoing
1.9-/1.5-μm
DEELT for upper and lower gastrointestinal bleeding due to vascular lesions were enrolled in three academic referral centers. Safety and successful ablation of vascular lesions were the primary outcomes. Long-term hemoglobin level, blood transfusion requirements, endoscopic severity scores of complex vascular disorders and technical lasing parameters were also assessed. Long-term hemoglobin variations have been further assessed, with repeated measure analysis of variance and univariate analyses.
Results
Fifty patients (median age 74; range 47 to 91 years) with gastric antral vascular ectasia (GAVE) (22), angioectasia (22) and radiation proctopathy (6) underwent 58
1.9-/1.5-μm
DEELT between 2016 and 2020. All procedures were technically feasible leading to successful ablation of the targeted lesion/s, with no incident or adverse event potentially related to the
1.9-/1.5-μm
DEELT technique. Within a 6-month follow-up, hemoglobin values significantly rose (+ 1.77 at 1 month and + 1.70 g/dL at 6 months,
P
< 0.01), the blood supply requirement decreased (at least one transfusion in 32 versus 13 patients,
P
< 0.01), and GAVE lesions showed a clear endoscopic improvement (from 5 points to 1 points,
P
< 0.01).
Conclusions
The 1.9-/1.5-μm laser system is a safe and effective endoscopic tool for haemostatic ablation of bleeding vascular lesions within the gastrointestinal tract in tertiary referral centers.
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Affiliation(s)
- Gian Eugenio Tontini
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy,Department of Pathophysiology and Organ Transplantation, University of Milan, Milan, Italy,Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Dioscoridi
- Digestive and Interventional Endoscopy Unit, Niguarda Hospital, ASST Niguarda, Milan, Italy
| | - Alessandro Rimondi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy,Postgraduate Specialization in Gastrointestinal Diseases, University of Milan, Milan, Italy
| | - Paolo Cantù
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Flaminia Cavallaro
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy,Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Aurora Giannetti
- Digestive and Interventional Endoscopy Unit, Niguarda Hospital, ASST Niguarda, Milan, Italy,Gastroenterology and Endoscopy Unit, IRCCS Multimedica, Sesto San Giovanni, Milano
| | - Luca Elli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Pastorelli
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Francesco Pugliese
- Digestive and Interventional Endoscopy Unit, Niguarda Hospital, ASST Niguarda, Milan, Italy
| | - Massimiliano Mutignani
- Digestive and Interventional Endoscopy Unit, Niguarda Hospital, ASST Niguarda, Milan, Italy
| | - Maurizio Vecchi
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy,Department of Pathophysiology and Organ Transplantation, University of Milan, Milan, Italy,Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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18
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Shimizu T, Samarasena JB, Fortinsky KJ, Hashimoto R, El Hage Chehade N, Chin MA, Moosvi Z, Chang KJ. Benefit, tolerance, and safety of hybrid argon plasma coagulation for treatment of Barrett's esophagus: US pilot study. Endosc Int Open 2021; 9:E1870-E1876. [PMID: 34917455 PMCID: PMC8671001 DOI: 10.1055/a-1492-2450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 05/29/2020] [Indexed: 12/19/2022] Open
Abstract
Background and study aims A novel technique for Barrett's esophagus (BE) ablation, termed hybrid APC, has recently been developed. The aims of this US pilot study were to evaluate the efficacy, tolerance and safety of hybrid APC for the treatment of BE. Patients and methods Patients with biopsy-proven BE referred to our tertiary care center over a 12-month period for mucosal ablation were eligible for this study. Efficacy of ablation was measured on follow-up endoscopy by demonstrating either a reduction of visible BE or biopsies proving complete resolution of intestinal metaplasia (CRIM). To evaluate tolerance and safety, patients were called on post-procedure days 1 and 7. Results Twenty-two patients with BE (4.5 % intramucosal carcinoma, 31.8 % high-grade dysplasia, 18.1 % low-grade dysplasia, 36.3 % non-dysplastic, 9.1 % indefinite for dysplasia) underwent 40 treatments with hybrid APC. All patients had endoscopic improvement of BE disease and 19 of 22 patients (86.4 %) achieved CRIM. With regard to tolerance, average pain scores (0 to 10 scale) on follow-up were 2.65 and 0.62 on days 1 and 7, respectively. With regards to safety, there were two treatment-related strictures (9.1 %) that required a single balloon dilation. Conclusions Hybrid APC appears to be promising in the treatment of BE. The ablation protocol used in this study demonstrated efficacy, tolerability, and a safety profile similar to radiofrequency ablation. Given the significant price difference between hybrid APC and other modalities for Barrett's ablation, this modality may be more cost-effective. These results warrant further study in a large prospective multicenter trial.
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Affiliation(s)
- Toshitaka Shimizu
- H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology & Hepatology, Department of Medicine, University of California, Irvine, Orange, California, United States
| | - Jason B. Samarasena
- H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology & Hepatology, Department of Medicine, University of California, Irvine, Orange, California, United States
| | - Kyle J. Fortinsky
- H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology & Hepatology, Department of Medicine, University of California, Irvine, Orange, California, United States
| | - Rintaro Hashimoto
- H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology & Hepatology, Department of Medicine, University of California, Irvine, Orange, California, United States
| | - Nabil El Hage Chehade
- H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology & Hepatology, Department of Medicine, University of California, Irvine, Orange, California, United States
| | - Matthew A. Chin
- H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology & Hepatology, Department of Medicine, University of California, Irvine, Orange, California, United States
| | - Zain Moosvi
- H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology & Hepatology, Department of Medicine, University of California, Irvine, Orange, California, United States
| | - Kenneth J. Chang
- H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology & Hepatology, Department of Medicine, University of California, Irvine, Orange, California, United States
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19
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Maselli R, Belletrutti PJ, Spadaccini M, Galteri PA, Stäbler T, Ederer M, Neugebauer A, Enderle MD, Repici A. Fluid cushion protects against thermal damage during argon plasma coagulation. Ann Gastroenterol 2021; 34:845-851. [PMID: 34815651 PMCID: PMC8596213 DOI: 10.20524/aog.2021.0667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 06/16/2021] [Indexed: 12/04/2022] Open
Abstract
Background Thermal damage to the muscle layer during mucosal application of argon plasma coagulation (APC) may be avoided by creating a fluid cushion within the submucosal layer, but the minimum injection volume needed or the ideal injection fluid are yet to be established. We conducted a systematic ex vivo study with this aim. Methods All experiments were performed in an ex vivo porcine gastrointestinal tract model. Five different fluids (saline, Glyceol, Gelafundin, Voluven, and Eleview) of different volumes were injected into the submucosa of different parts of the gastrointestinal tract. APC was applied to the mucosa at different power settings. Immediately after APC treatment, the temperature was measured through a thermocouple placed inside the fluid cushion, just on top of the muscle layer. The minimum volume of fluid needed to protect the muscle layer from thermal damage was determined. Results There was no difference in the temperature measured among the different injection fluids at the surface of the muscle, in all the locations, at equal injection volumes and power settings. The minimum amounts of fluid needed to protect the muscle layer were 2 and 3 mL for power settings of 30-90 W and 90-120 W, respectively. Conclusions Normal saline and 4 commercially available submucosal injection fluids possess similar thermal protective effects. To reduce the likelihood of thermal damage to deeper layers when APC is applied, a minimum injection volume of 3 mL is recommended if less than 90 W power will be utilized over 3 sec.
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Affiliation(s)
- Roberta Maselli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy (Roberta Maselli, Marco Spadaccini, Alessandro Repici).,Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy (Roberta Maselli, Paul J. Belletrutti, Marco Spadaccini, Piera Alessia Galteri, Alessandro Repici)
| | - Paul J Belletrutti
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy (Roberta Maselli, Paul J. Belletrutti, Marco Spadaccini, Piera Alessia Galteri, Alessandro Repici)
| | - Marco Spadaccini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy (Roberta Maselli, Marco Spadaccini, Alessandro Repici).,Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy (Roberta Maselli, Paul J. Belletrutti, Marco Spadaccini, Piera Alessia Galteri, Alessandro Repici)
| | - Piera Alessia Galteri
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy (Roberta Maselli, Paul J. Belletrutti, Marco Spadaccini, Piera Alessia Galteri, Alessandro Repici)
| | - Thomas Stäbler
- Research Department Erbe Elektromedizin GmbH, Tubingen, Germany (Thomas Stäbler, Michael Ederer, Alexander Neugebauer, Markus D. Enderle)
| | - Michael Ederer
- Research Department Erbe Elektromedizin GmbH, Tubingen, Germany (Thomas Stäbler, Michael Ederer, Alexander Neugebauer, Markus D. Enderle)
| | - Alexander Neugebauer
- Research Department Erbe Elektromedizin GmbH, Tubingen, Germany (Thomas Stäbler, Michael Ederer, Alexander Neugebauer, Markus D. Enderle)
| | - Markus D Enderle
- Research Department Erbe Elektromedizin GmbH, Tubingen, Germany (Thomas Stäbler, Michael Ederer, Alexander Neugebauer, Markus D. Enderle)
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Milan, Italy (Roberta Maselli, Marco Spadaccini, Alessandro Repici).,Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy (Roberta Maselli, Paul J. Belletrutti, Marco Spadaccini, Piera Alessia Galteri, Alessandro Repici)
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20
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Condon A, Muthusamy VR. The evolution of endoscopic therapy for Barrett's esophagus. Ther Adv Gastrointest Endosc 2021; 14:26317745211051834. [PMID: 34708204 PMCID: PMC8543722 DOI: 10.1177/26317745211051834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 09/21/2021] [Indexed: 12/20/2022] Open
Abstract
Barrett’s esophagus is the condition in which a metaplastic columnar epithelium
replaces the stratified squamous epithelium that normally lines the distal
esophagus. The condition develops as a consequence of chronic gastroesophageal
reflux disease and predisposes the patient to the development of esophageal
adenocarcinoma. The diagnosis and management of Barrett’s esophagus have
undergone dramatic changes over the years and continue to evolve today.
Endoscopic eradication therapy has revolutionized the management of dysplastic
Barrett’s esophagus and early esophageal adenocarcinoma by significantly
reducing the morbidity and mortality associated with the prior gold standard of
therapy, esophagectomy. The purpose of this review is to highlight current
principles in the management and endoscopic treatment of this disease.
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Affiliation(s)
- Ashwinee Condon
- Vatche & Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - V Raman Muthusamy
- Vatche & Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, UCLA, 200 UCLA Medical Plaza, Room 330-37, Los Angeles, CA 90095, USA
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21
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Kolb JM, Shah S, Chahine A, Chang K, Samarasena JB. Hybrid argon plasma coagulation for Barrett's esophagus. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2021; 6:339-341. [PMID: 34401625 PMCID: PMC8353141 DOI: 10.1016/j.vgie.2021.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Video 1Hybrid APC for Barrett's esophagus.
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Affiliation(s)
- Jennifer M Kolb
- H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Department of Medicine, Orange, California
| | - Sagar Shah
- University of California, Irvine School of Medicine, Orange, California
| | - Anastasia Chahine
- H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Department of Medicine, Orange, California
| | - Kenneth Chang
- H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Department of Medicine, Orange, California
| | - Jason B Samarasena
- H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Department of Medicine, Orange, California
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22
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Staudenmann DA, Skacel EP, Tsoutsman T, Kaffes AJ, Saxena P. Safety and long-term efficacy of hybrid-argon plasma coagulation for the treatment of Barrett's esophagus: An Australian pilot study (with video). INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2021. [DOI: 10.18528/ijgii200050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | - Tatiana Tsoutsman
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia
- The University of Sydney School of Medicine, Sydney, Australia
| | - Arthur John Kaffes
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia
- The University of Sydney School of Medicine, Sydney, Australia
| | - Payal Saxena
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia
- The University of Sydney School of Medicine, Sydney, Australia
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23
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McGoran JJ, Ragunath K. Endoscopic management of Barrett's esophagus: Western perspective of current status and future prospects. Dig Endosc 2021; 33:720-729. [PMID: 32790886 DOI: 10.1111/den.13812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 08/03/2020] [Accepted: 08/11/2020] [Indexed: 02/08/2023]
Abstract
Barrett's esophagus (BE) is a precursor to esophageal adenocarcinoma and current practice is to establish endoscopic surveillance once diagnosed, in order to identify early dysplasia and neoplasia that has the potential to undergo endoscopic eradication therapy (EET). Before embarking upon EET the clinical team has a duty to consider all viable options and come to a plan based on recent evidence. The therapeutic approach varies greatly but largely adheres to the mantra of 'Detect-Resect-Ablate', in which high-quality endoscopy identifies BE associated pathology, associated lesions (if present) undergo safe endoscopic resection and remaining intestinal metaplasia in the esophagus is ablated to prevent recurrence of dysplasia. In this review, current practice, pitfalls, complications, and the future perspectives on practice in this field are discussed. The Western perspective is focused on here, with an outline of the differences in clinical practice with Asian nations and attempts to bridge these differences.
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Affiliation(s)
- John J McGoran
- Department of Digestive Diseases, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Krish Ragunath
- Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, WA, Australia
- Curtin University Medical School, Perth, WA, Australia
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24
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Zhang L, Sun B, Zhou X, Wei Q, Liang S, Luo G, Li T, Lü M. Barrett's Esophagus and Intestinal Metaplasia. Front Oncol 2021; 11:630837. [PMID: 34221959 PMCID: PMC8252963 DOI: 10.3389/fonc.2021.630837] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/31/2021] [Indexed: 02/05/2023] Open
Abstract
Intestinal metaplasia refers to the replacement of the differentiated and mature normal mucosal epithelium outside the intestinal tract by the intestinal epithelium. This paper briefly describes the etiology and clinical significance of intestinal metaplasia in Barrett’s esophagus. This article summarizes the impact of intestinal metaplasia on the diagnosis, monitoring, and treatment of Barrett’s esophagus according to different guidelines. We also briefly explore the basis for the endoscopic diagnosis of intestinal metaplasia in Barrett’s esophagus. The identification techniques of goblet cells in Barrett’s esophagus are also elucidated by some scholars. Additionally, we further elaborate on the current treatment methods related to Barrett’s esophagus.
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Affiliation(s)
- Lu Zhang
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou City, China
| | - Binyu Sun
- Department of Endoscope, Public Health Clinical Medical Center of Chengdu, Chengdu City, China
| | - Xi Zhou
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou City, China
| | - QiongQiong Wei
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou City, China
| | - Sicheng Liang
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou City, China
| | - Gang Luo
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou City, China
| | - Tao Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu City, China
| | - Muhan Lü
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou City, China
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25
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Estifan E, Cavanagh Y, Grossman MA. Hybrid Argon Plasma Coagulation for Treatment of Gastric Intestinal Metaplasia. Cureus 2020; 12:e7427. [PMID: 32337147 PMCID: PMC7182158 DOI: 10.7759/cureus.7427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Hybrid argon plasma coagulation (HybridAPC® [HAPC]) is an evolution of the standard argon plasma coagulation (APC) technology, where the application of APC is preceded by high-pressure needleless submucosal injection. APC is indicated for the ablation of benign and dysplastic mucosal lesions, such as vascular malformations or Barrett's mucosa. HAPC offers safety and efficacy advantages over standard APC because the submucosal injection acts as a heat sink that disperses energy. This ensures that the underlying muscularis propria remains unaffected, and only the mucosal layer is coagulated in its entirety. An 81-year-old Hispanic male was found to have a 1.2-cm mucosal nodule along the incisura of the stomach. Pathology of the biopsy specimen revealed high-grade dysplasia, and he subsequently underwent endoscopic ultrasound examination, which confirmed the presence of an isolated gastric nodule with no deep invasion of the muscularis propria, consistent with a uT1N0Mx endosonographic staging. He then underwent endoscopic submucosal dissection of the lesion. Pathology of the excised specimen confirmed the presence of multifocal high-grade dysplasia, arising in the background of extensive intestinal metaplasia. The deep margin was clear; however, the lateral resection margins showed focal involvement of intestinal metaplasia with low-grade dysplasia. Surveillance endoscopy confirmed the persistence of diffuse intestinal metaplasia. He was then treated with widespread HAPC due to the presence of underlying diffuse intestinal metaplasia in the stomach. HAPC is an effective and efficient treatment modality for mucosal lesions. In one series of 50 patients, 96% achieved complete macroscopic remission of Barrett's mucosa after a median of 3.5 APC sessions, and 85% achieved complete histological remission. HAPC is a promising therapeutic modality as a thermal injury is targeted, and the depth of injury is contained. This provides immediate procedural efficacy and safety benefits, and reduces subsequent complications when compared with standard APC. We anticipate that the applications of HAPC will continue to grow, as this modality is adopted into common procedural parlance. This case appears to be the first to describe the use of HAPC for definitive treatment of diffuse intestinal metaplasia.
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Affiliation(s)
- Elias Estifan
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Yana Cavanagh
- Interventional Gastroenterology, St. Joseph's University Medical Center, Paterson, USA
| | - Matthew A Grossman
- Interventional Gastroenterology, St. Joseph's University Medical Center, Paterson, USA
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26
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Fayad L, Oberbach A, Schweitzer M, Askin F, Voltaggio L, Larman T, Enderle M, Hahn H, Khashab MA, Kalloo AN, Kumbhari V. Gastric mucosal devitalization (GMD): translation to a novel endoscopic metabolic therapy. Endosc Int Open 2019; 7:E1640-E1645. [PMID: 31788546 PMCID: PMC6877422 DOI: 10.1055/a-0957-3067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/27/2019] [Indexed: 01/08/2023] Open
Abstract
Background and study aims The metabolic effects of bariatric surgery may partially result from removal of the gastric mucosa, an often underappreciated endocrine organ. Using argon plasma coagulation (APC), we may be able to selectively devitalize (ablate) the mucosa. The aim of this study was to identify the optimal tissue color that would correspond to selective gastric mucosal devitalization (GMD) using ex-vivo human stomach specimens. Patients and methods Stomach specimens were obtained at sleeve gastrectomy. Prior to APC application, a submucosal fluid cushion was created. APC was then applied over a 2 × 2-cm area to the fundus and body, aiming for the three indicator colors (white, golden, brown). Pathological analysis was then performed independently and in a blinded fashion by two pathologists to determine the depth of mucosal and submucosal percent thermal injury and mucosal percent cell death. Results Six patients were enrolled. There was a significant correlation between tissue color and mucosal percent thermal injury. The highest percent mucosal thermal injury was seen with brown (99.6 %, 95 % CI: 98.7, 100), followed by golden (92.5 %, 95 % CI: 85.5, 99.5), and then white (75.2 %, 95 % CI: 58.3, 92.1, P < 0.01). Submucosal thermal injury was seen in 88.9 % of the slides. Greater than minimal submucosal injury (> 10 % depth) was found significantly more with brown tissue color (91.6 %) than golden (75 %) or white (33.3 %, P < 0.05). However, 91.7 % of the entire sample set < 50 % injury. Conclusion GMD is achievable using APC without thermal injury to muscularis propria. A golden color results in sufficient mucosal injury with only superficial injury to the submucosa.
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Affiliation(s)
- Lea Fayad
- Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
| | - Andreas Oberbach
- Johns Hopkins Medical Institutions, Baltimore, Maryland, United States,Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | | | - Frederic Askin
- Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
| | | | - Tatianna Larman
- Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
| | | | | | - Mouen A. Khashab
- Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
| | - Anthony N. Kalloo
- Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
| | - Vivek Kumbhari
- Johns Hopkins Medical Institutions, Baltimore, Maryland, United States,Corresponding author Vivek Kumbhari, Associate Professor of Medicine Division of Gastroenterology and HepatologyDirector of Bariatric EndoscopyJohns Hopkins Medical InstitutionsSheikh Zayed Building1800 Orleans Street, Suite 7125GBaltimore, MD 21287
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27
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Zheng X, Herth FJF, Sun J. Initial Experience with Hybrid Argon Plasma Coagulation as a Novel Local Treatment Method for Tracheobronchial Mucoepidermoid Carcinoma. Respiration 2019; 98:461-466. [PMID: 31563905 DOI: 10.1159/000501239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/30/2019] [Indexed: 11/19/2022] Open
Abstract
Tracheobronchial mucoepidermoid carcinoma (MEC) is a type of salivary gland tumor. Surgical resection is the main treatment for MEC, but it is associated with risks. Hybrid argon plasma coagulation (HybridAPC®) is an innovative technique combining APC with a water cushion function which can be used for the treatment of MEC. We aimed to evaluate the efficacy and safety of HybridAPC for MEC in 2 patients diagnosed with MEC based on histological examination of biopsies. Full preoperative assessments were done by white-light bronchoscopy, autofluorescence imaging, narrow-band imaging, and radial probe endobronchial ultrasound. HybridAPC was administered after these evaluations. Both patients were followed up for more than 3 months. HybridAPC ablation was completed successfully, with no complications. HybridAPC thus appears to be a safe and efficient treatment for MEC.
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Affiliation(s)
- Xiaoxuan Zheng
- Department of Respiratory Endoscopy and Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Felix J F Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg, Heidelberg, Germany
| | - Jiayuan Sun
- Department of Respiratory Endoscopy and Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China, .,Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China,
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28
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Abstract
Endoscopic resection for early esophageal cancer is a very precise endoscopic surgical technique and having experience in endoscopic resection is mandatory to perform these kinds of procedures safely. In case of adequate resection and favorable histological outcome, long-term prognosis of the patient is excellent. The basic principle for endoscopic treatment of early adenocarcinoma is based on the fact that the risk of lymph node metastasis gradually increases with the depth of invasion. Inspection and evaluation of all mucosal and submucosal lesions need to be done carefully before endoscopic resection. Endoscopic resection of mucosal (T1m1-3) and superficial submucosal (T1sm1) adenocarcinoma can be curative as well as for superficial mucosal (T1m1-m2) squamous cell carcinoma. In Paris type I lesions in Barrett's esophagus and for early squamous cell carcinoma endoscopic submucosal dissection (ESD) is the preferred option. The risk of severe adverse events associated with endoscopic resection are low. Most adverse events are managed endoscopically and can be treated conservatively. Endoscopic radiofrequency ablation is the most widely used ablation technique for Barrett's epithelium and highly effective to achieve full remission of dysplasia and intestinal metaplasia. The role of radiofrequency ablation in the treatment armamentarium in squamous cell carcinoma of the esophagus has still to be determined.
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Affiliation(s)
- Irma C Noordzij
- Department of Gastroenterology and Hepatology, Catharina Cancer Institute, Catharina Hospital, Eindhoven, The Netherlands
| | - Wouter L Curvers
- Department of Gastroenterology and Hepatology, Catharina Cancer Institute, Catharina Hospital, Eindhoven, The Netherlands
| | - Erik J Schoon
- Department of Gastroenterology and Hepatology, Catharina Cancer Institute, Catharina Hospital, Eindhoven, The Netherlands
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29
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Chang KJ. Endoscopic foregut surgery and interventions: The future is now. The state-of-the-art and my personal journey. World J Gastroenterol 2019; 25:1-41. [PMID: 30643356 PMCID: PMC6328959 DOI: 10.3748/wjg.v25.i1.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 02/06/2023] Open
Abstract
In this paper, I reviewed the emerging field of endoscopic surgery and present data supporting the contention that endoscopy can now be used to treat many foregut diseases that have been traditionally treated surgically. Within each topic, the content will progress as follows: "lessons learned", "technical considerations" and "future opportunities". Lessons learned will provide a brief background and update on the most current literature. Technical considerations will include my personal experience, including tips and tricks that I have learned over the years. Finally, future opportunities will address current unmet needs and potential new areas of development. The foregut is defined as "the upper part of the embryonic alimentary canal from which the pharynx, esophagus, lung, stomach, liver, pancreas, and part of the duodenum develop". Foregut surgery is well established in treating conditions such as gastroesophageal reflux disease (GERD), achalasia, esophageal diverticula, Barrett's esophagus (BE) and esophageal cancer, stomach cancer, gastric-outlet obstruction, and obesity. Over the past decade, remarkable progress in interventional endoscopy has culminated in the conceptualization and practice of endoscopic foregut surgery for various clinical conditions summarized in this paper. Regarding GERD, there are now several technologies available to effectively treat it and potentially eliminate symptoms, and the need for long-term treatment with proton pump inhibitors. For the first time, fundoplication can be performed without the need for open or laparoscopic surgery. Long-term data going out 5-10 years are now emerging showing extended durability. In respect to achalasia, per-oral endoscopic myotomy (POEM) which was developed in Japan, has become an alternative to the traditional Heller's myotomy. Recent meta-analysis show that POEM may have better results than Heller, but the issue of post-POEM GERD still needs to be addressed. There is now a resurgence of endoscopic treatment of Zenker's diverticula with improved technique (Z-POEM) and equipment; thus, patients are choosing flexible endoscopic treatment as opposed to open or rigid endoscopy options. In regard to BE, endoscopic submucosal dissection (ESD) which is well established in Asia, is now becoming more mainstream in the West for the treatment of BE with high grade dysplasia, as well as early esophageal cancer. In combination with all the ablation technologies (radiofrequency ablation, cryotherapy, hybrid argon plasma coagulation), the entire spectrum of Barrett's and related dysplasia and early cancer can be managed predominantly by endoscopy. Importantly, in regard to early gastric cancer and submucosal tumors (SMTs) of the stomach, ESD and full thickness resection (FTR) can excise these lesions en-bloc and endoscopic suturing is now used to close large defects and perforations. For treatment of patients with malignant gastric outlet obstruction (GOO), endoscopic gastro-jejunostomy is now showing better results than enteral stenting. G-POEM is also emerging as a treatment option for patients with gastroparesis. Obesity has become an epidemic in many western countries and is becoming also prevalent in Asia. Endoscopic sleeve gastroplasty (ESG) is now becoming an established treatment option, especially for obese patients with body mass index between 30 and 35. Data show an average weight loss of 16 kg after ESG with long-term data confirming sustainability. Finally, in respect to endo-hepatology, there are many new endoscopic interventions that have been developed for patients with liver disease. Endoscopic ultrasound (EUS)-guided liver biopsy and EUS-guided portal pressure measurement are exciting new frontiers for the endo-hepatologists.
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Affiliation(s)
- Kenneth J Chang
- H.H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, CA 92868, United States
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30
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Kraemer B, Scharpf M, Keckstein S, Dippon J, Tsaousidis C, Brunecker K, Enderle MD, Neugebauer A, Nuessle D, Fend F, Brucker S, Taran FA, Kommoss S, Rothmund R. A prospective randomized experimental study to investigate the peritoneal adhesion formation after waterjet injection and argon plasma coagulation (HybridAPC) in a rat model. Arch Gynecol Obstet 2018; 297:961-967. [PMID: 29362925 DOI: 10.1007/s00404-018-4661-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/09/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND This prospective, randomized, controlled, single-blinded study investigates the peritoneal adhesion formation of HybridAPC (waterjet elevation of the peritoneum with subsequent argon plasma coagulation) versus only waterjet (elevation with the same instrument, but without subsequent argon plasma coagulation) in a rat model (24 female Wistar rats). MATERIALS AND METHODS Bilateral lesions were created on the abdominal wall with HybridAPC on one sidewall and waterjet elevation on the other sidewall of the peritoneum in a standard fashion. After 10 days, the rats were euthanized to evaluate the peritoneal trauma sites. MAIN OUTCOME MEASURE(S) Adhesion incidence, quantity, and quality were scored 10 days postoperatively and studied histopathologically. RESULT(S) Incidence of adhesion formation was 2.3% for HybridAPC; no adhesions occurred for peritoneal elevation with saline (p = 1.00). Histologic evaluation revealed no acute inflammation in both groups. An overall moderate degree of granulation tissue formation and myonecrosis was observed in the HybridAPC group, whereas no chronic inflammation and myonecrosis occurred after elevation without thermal ablation (p < 0.0001). CONCLUSION(S) This study investigates the effect of waterjet elevation of the peritoneum with and without subsequent thermal ablation on adhesion formation in a rat model for the first time. Peritoneal waterjet elevation with saline does not provide any risk of adhesion formation. Thermal coagulation with APC after waterjet elevation of the peritoneum creates advantageous peritoneal conditions due to a permanent moist tissue surface and the cooling effect of the injected solution, resulting in no significant difference in adhesion formation compared to peritoneal elevation without thermal ablation. HybridAPC can thus be regarded as a beneficial coagulation method with only minor adhesion formation due to positive tissue effects of the combined waterjet.
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Affiliation(s)
- Bernhard Kraemer
- Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstr. 7, 72076, Tübingen, Germany.
| | - Marcus Scharpf
- Department of Pathology, University of Tuebingen, Liebermeisterstr. 8, 72076, Tübingen, Germany
| | - Simon Keckstein
- Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstr. 7, 72076, Tübingen, Germany
| | - Julia Dippon
- Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstr. 7, 72076, Tübingen, Germany
| | - Christos Tsaousidis
- Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstr. 7, 72076, Tübingen, Germany
| | - Kristin Brunecker
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072, Tübingen, Germany
| | | | | | - Daniela Nuessle
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072, Tübingen, Germany
| | - Falko Fend
- Department of Pathology, University of Tuebingen, Liebermeisterstr. 8, 72076, Tübingen, Germany
| | - Sara Brucker
- Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstr. 7, 72076, Tübingen, Germany
| | - Florin-Andrei Taran
- Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstr. 7, 72076, Tübingen, Germany
| | - Stefan Kommoss
- Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstr. 7, 72076, Tübingen, Germany
| | - Ralf Rothmund
- Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstr. 7, 72076, Tübingen, Germany
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31
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di Pietro M, Canto MI, Fitzgerald RC. Endoscopic Management of Early Adenocarcinoma and Squamous Cell Carcinoma of the Esophagus: Screening, Diagnosis, and Therapy. Gastroenterology 2018; 154:421-436. [PMID: 28778650 PMCID: PMC6104810 DOI: 10.1053/j.gastro.2017.07.041] [Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/24/2017] [Accepted: 07/26/2017] [Indexed: 12/16/2022]
Abstract
Because the esophagus is easily accessible with endoscopy, early diagnosis and curative treatment of esophageal cancer is possible. However, diagnosis is often delayed because symptoms are not specific during early stages of tumor development. The onset of dysphagia is associated with advanced disease, which has a survival at 5 years lower than 15%. Population screening by endoscopy is not cost-effective, but a number of alternative imaging and cell analysis technologies are under investigation. The ideal screening test should be inexpensive, well tolerated, and applicable to primary care. Over the past 10 years, significant progress has been made in endoscopic diagnosis and treatment of dysplasia (squamous and Barrett's), and early esophageal cancer using resection and ablation technologies supported by evidence from randomized controlled trials. We review the state-of-the-art technologies for early diagnosis and minimally invasive treatment, which together could reduce the burden of disease.
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Affiliation(s)
| | - Marcia I Canto
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland
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32
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Pech O. Hybrid Argon Plasma Coagulation in Patients With Barrett Esophagus. Gastroenterol Hepatol (N Y) 2017; 13:610-612. [PMID: 29230137 PMCID: PMC5718177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Oliver Pech
- Professor of Medicine Head of Gastroenterology and Interventional Endoscopy St John of God Hospital Regensburg, Germany
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33
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Hamade N, Sharma P. Ablation Therapy for Barrett's Esophagus: New Rules for Changing Times. Curr Gastroenterol Rep 2017; 19:48. [PMID: 28819902 DOI: 10.1007/s11894-017-0589-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW In this review, we discuss different endoscopic techniques in the eradication of Barrett's esophagus (BE) as well as some controversies in the field of treatment. RECENT FINDINGS Patients with T1a esophageal adenocarcinoma and BE of high-grade dysplasia should undergo endoscopic ablative therapy. The most studied technique to date is radiofrequency ablation. It can be combined with endoscopic mucosal resection in cases containing nodular and flat lesions. Cryotherapy and APC have shown promise with good efficacy and safety profiles so far, but are not mainstream as more studies are needed. Surveillance is still required post-ablation since recurrence is common. Low-grade dysplasia can be treated with either endo-ablative therapy or surveillance. Non-dysplastic BE treatment is controversial and so far, only surveillance is recommended. Research is ongoing to better risk stratify these patients. Our ability to diagnose and treat BE has come a long way in the past few years with the goal of preventing its progression into malignancy. The advent of endoscopic techniques in the eradication of BE has provided a less invasive and safer modality of treatment as compared to surgical esophagectomy. Data in the form of randomized trials and high-volume registries has provided good evidence to support the efficacy of these techniques and their long-term durability.
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Affiliation(s)
- Nour Hamade
- Department of Internal Medicine, University of Kansas School of Medicine and Veterans Affairs Medical Center, Kansas City, MI, USA
| | - Prateek Sharma
- Department of Internal Medicine, University of Kansas School of Medicine and Veterans Affairs Medical Center, Kansas City, MI, USA. .,Department of Gastroenterology, Department of Veterans Affairs Medical Center, 4801 E. Linwood Boulevard, Kansas City, MI, 64128, USA.
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34
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Pana M, Sansone S, Fernandez-Sordo JO, Ragunath K. Endoscopic treatment for Barrett's oesophagus dysplasia and early cancer. GASTROINTESTINAL NURSING 2017; 15:18-25. [DOI: 10.12968/gasn.2017.15.6.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2025]
Abstract
Endoscopic treatment of early Barrett's oesophagus neoplasia is now proven to be a safe and effective alternative to oesophagectomy. An ideal candidate for endoscopic treatment should have dysplasia or carcinoma limited to the mucosa or superficial submucosa without lymphovascular invasion or poor differentiation. Two main types of endoscopic therapies are used: (1) endoscopic resection, which comprises of endoscopic mucosal resection or endoscopic submucosal dissection for removal of visible lesions en bloc and (2) endoscopic ablation utilising argon plasma coagulation, radiofrequency ablation or, more recently, cryotherapy. Although endoscopic resection is the cornerstone for Barrett's endotherapy, ablative techniques are complementary in achieving complete eradication of the columnar epithelium and dysplasia.
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Affiliation(s)
- Mirela Pana
- Research Fellow, National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, University of Nottingham and Nottingham University Hospitals NHS Trust
| | - Stefano Sansone
- Consultant Gastroenterologist, National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, University of Nottingham and Nottingham University Hospitals NHS Trust
| | - Jacobo Ortiz Fernandez-Sordo
- Consultant Gastroenterologist, National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, University of Nottingham and Nottingham University Hospitals NHS Trust
| | - Krish Ragunath
- Professor of Gastrointestinal Endoscopy and Consultant Gastroenterologist; National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, University of Nottingham and Nottingham University Hospitals NHS Trust
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Nishikawa T, Hata K, Yoshida S, Murono K, Yasuda K, Otani K, Tanaka T, Kiyomatsu T, Kawai K, Nozawa H, Ishihara S, Koike K, Watanabe T. Successful endoscopic treatment of stapled J-pouch ileoanal canal anastomotic hemorrhage by argon plasma coagulation: a case report. J Med Case Rep 2016; 10:309. [PMID: 27809887 PMCID: PMC5094016 DOI: 10.1186/s13256-016-1103-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 10/12/2016] [Indexed: 11/30/2022] Open
Abstract
Background Continuous lower gastrointestinal hemorrhage is a rare condition, but it often requires proper management. We report a case of a patient with gastrointestinal hemorrhage 18 years after stapled J-pouch ileoanal canal anastomosis who was successfully treated with argon plasma coagulation. Case presentation Our patient was a 54-year-old Japanese man who had developed ulcerative colitis 28 years ago. A J-shaped ileal pouch-anal anastomosis with a double-staple technique was indicated 18 years ago when the patient became refractory to the conventional medication. When he presented to our hospital, 18 years after the operation, the patient complained of faintness and fresh blood in the stool of 2 days’ duration, and was admitted for investigation. Lower endoscopy revealed that the hemorrhage was from a neovascularization area close to the site of ileal pouch-anal anastomosis. Cap-assisted argon plasma coagulation was carried out for hemostasis, and complete hemostasis was achieved without complications. Conclusions We present a case of a patient with hemorrhage following a J-shaped ileal pouch-anal anastomosis with a double-staple technique performed 18 years ago. Argon plasma coagulation treatment was successful, suggesting the potential safety and effectiveness of colonoscopic electrocoagulation for controlling unremitting hemorrhage from a neovascularization area around a stapled ileoanal canal anastomotic site.
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Affiliation(s)
- Takeshi Nishikawa
- Department of Surgical Oncology, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Keisuke Hata
- Department of Surgical Oncology, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shuntaro Yoshida
- Department of Gastroenterology, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Koji Murono
- Department of Surgical Oncology, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Koji Yasuda
- Department of Surgical Oncology, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kensuke Otani
- Department of Surgical Oncology, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Toshiaki Tanaka
- Department of Surgical Oncology, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tomomichi Kiyomatsu
- Department of Surgical Oncology, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kazushige Kawai
- Department of Surgical Oncology, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Toshiaki Watanabe
- Department of Surgical Oncology, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Nabi Z. Complications of therapeutic gastroscopy/colonoscopy other than resection. Best Pract Res Clin Gastroenterol 2016; 30:719-733. [PMID: 27931632 DOI: 10.1016/j.bpg.2016.10.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/07/2016] [Accepted: 10/21/2016] [Indexed: 01/31/2023]
Abstract
Gastrointestinal (GI) endoscopy is profoundly utilized for diagnostic and therapeutic purposes. The therapeutic potential of GI endoscopy has amplified many folds with the evolution of novel techniques as well as equipments. However, with the augmentation of therapeutic endoscopy, the extent, likelihood and severity of adverse events have increased as well. The attendant risks and adverse events with therapeutic endoscopy are many folds that of diagnostic endoscopy. Besides endoscopic resection, therapeutic endoscopy is widely utilized for hemostasis in GI bleeds, dilatation of stenosis, enteral stenting, foreign body removal, ablation of Barrett's esophagus etc. Major adverse events associated with interventional endoscopic procedures include bleeding and perforation. Adverse events of endoscopic interventions are diverse and related to the underlying disease, therapeutic modality used and operator's experience. Many of these adverse events can be prevented. Early recognition of an unavoidable adverse event is important to minimize the associated morbidity and mortality.
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Affiliation(s)
- Zaheer Nabi
- Asian Institute of Gastroenterology, Hyderabad, India.
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Manner H, May A, Kouti I, Pech O, Vieth M, Ell C. Efficacy and safety of Hybrid-APC for the ablation of Barrett's esophagus. Surg Endosc 2015; 30:1364-70. [PMID: 26104794 DOI: 10.1007/s00464-015-4336-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 05/04/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND STUDY AIM After thermal ablation of Barrett's esophagus (BE), stricture formation is reported in 5 to over 10% of patients. The question arises whether submucosal fluid injection prior to ablation may lower the risk of stricture formation. The aim of the present study was to evaluate the efficacy and safety of the new technique of Hybrid-APC which combines submucosal injection with APC. PATIENTS AND METHODS Patients who had a residual BE segment of at least 1 cm after endoscopic resection of early Barrett's neoplasia underwent thermal ablation of BE by Hybrid-APC. Prior to thermal ablation, submucosal injection of sodium chloride 0.9% was carried out using a flexible water-jet probe (Erbejet 2; Erbe Elektromedizin, Tuebingen, Germany). Check-up upper GI endoscopy was carried out 3 months after macroscopically complete ablation including biopsies from the neo-Z-line and the former BE segment, and recording of stricture formation. RESULTS From May 2011 to November 2012, a total of 60 patients (pt) were included in the study [55 pt male (92%); mean age 62 ± 9 years, range 42-79]. Ten patients were excluded from the study. In the remaining 50 pt, Hybrid-APC ablation and check-up endoscopy at 3 months were carried out. Forty-eight out of 50 pt (96%; ITT: 49/60, 82%) achieved macroscopically complete remission after a median of 3.5 APC sessions [SD 2.4; range 1-10]. Freedom from BE was histopathologically observed in 39/50 patients (78%). There was one treatment-related stricture (2%). Minor adverse events of Hybrid-APC were observed in 11 patients (22%). CONCLUSIONS According to this pilot series, Hybrid-APC was effective and safe for BE ablation in a tertiary referral center. The rate of stricture formation was only 2%. Further studies are required to confirm the present results. GERMAN CLINICAL TRIALS REGISTER DRKS00003369.
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Affiliation(s)
- Hendrik Manner
- Department of Internal Medicine II, HSK Hospital, Teaching Hospital of the University Medicine of Mainz, Ludwig-Erhard-Strasse 100, 65199, Wiesbaden, Germany.
| | - Andrea May
- Department of Internal Medicine, Sana Klinikum, Offenbach, Germany
| | - Ioanna Kouti
- Department of Internal Medicine II, HSK Hospital, Teaching Hospital of the University Medicine of Mainz, Ludwig-Erhard-Strasse 100, 65199, Wiesbaden, Germany
| | - Oliver Pech
- Department of Gastroenterology and Interventional Endoscopy, St. John of God Hospital, Regensburg, Germany
| | - Michael Vieth
- Institute of Pathology, Bayreuth Hospital, Bayreuth, Germany
| | - Christian Ell
- Department of Internal Medicine, Sana Klinikum, Offenbach, Germany
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Pech O. Endoscopic therapy of high-grade dysplasia and intramucosal adenocarcinoma: 2 small steps for the endoscopists but a fine step forward for the patient. Gastrointest Endosc 2015; 81:1167-9. [PMID: 25864893 DOI: 10.1016/j.gie.2015.01.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 01/22/2015] [Indexed: 12/20/2022]
Affiliation(s)
- Oliver Pech
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder (St. John of God Hospital), Teaching Hospital of the University of Regensburg, Regensburg, Germany
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