Shimizu Toshitaka, Samarasena Jason B, Fortinsky Kyle J, Hashimoto Rintaro, El Hage Chehade Nabil, Chin Matthew A, Moosvi Zain, Chang Kenneth J
H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology & Hepatology, Department of Medicine, University of California, Irvine, Orange, California, United States.
Endosc Int Open. 2021 Dec 14;9(12):E1870-E1876. doi: 10.1055/a-1492-2450. eCollection 2021 Dec.
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 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. 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. 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.
一种名为混合氩等离子体凝固术（hybrid APC）的巴雷特食管（BE）消融新技术最近已被开发出来。这项美国试点研究的目的是评估混合氩等离子体凝固术治疗BE的疗效、耐受性和安全性。在12个月期间转诊至我们三级医疗中心进行黏膜消融且活检证实为BE的患者符合本研究条件。通过内镜随访显示可见BE减少或活检证明肠化生完全消退（CRIM）来衡量消融疗效。为评估耐受性和安全性，在术后第1天和第7天对患者进行随访。22例BE患者（4.5%为黏膜内癌，31.8%为高级别异型增生，18.1%为低级别异型增生，36.3%为无异型增生，9.1%为异型增生不确定）接受了40次混合氩等离子体凝固术治疗。所有患者的BE疾病在内镜检查中均有改善，22例患者中有19例（86.4%）实现了CRIM。关于耐受性，随访时平均疼痛评分（0至10分制）在第1天和第7天分别为2.65和0.62。关于安全性，有2例（9.1%）与治疗相关的狭窄需要单次球囊扩张。混合氩等离子体凝固术在BE治疗中似乎很有前景。本研究中使用的消融方案显示出与射频消融相似的疗效、耐受性和安全性。鉴于混合氩等离子体凝固术与其他巴雷特消融方式之间存在显著价格差异，这种方式可能更具成本效益。这些结果值得在大型前瞻性多中心试验中进一步研究。
