Radiofrequency ablation versus hybrid argon plasma coagulation for dysplastic Barrett's esophagus: a...

Radiofrequency ablation (RFA) is the mainstay endoscopic therapy for dysplastic Barrett's esophagus (BE) but is frequently associated with postprocedural pain and dysphagia. Hybrid argon plasma coagulation (h-APC) may reduce thermal injury while maintaining efficacy. We aimed to compare procedure-related symptom burden, safety, and effectiveness of these two methods.

In this single-center, randomized-controlled trial, patients with dysplastic BE were randomized 1:1 to receive RFA or h-APC. The primary endpoint was 30-day postprocedural chest-pain burden per ablation, defined as the area under the curve (AUC) of 0-10 visual analog scores (VAS) obtained immediately post-procedure, at day 7, and at day 30. Secondary endpoints included dysphagia burden, esophageal-specific quality of life (QoL), adverse events, procedure duration, and rates of complete remission of intestinal metaplasia (CR-IM) and dysplasia (CR-D).

In total, 129 ablation sessions (67 RFA, 62 h-APC) in 62 patients were analyzed. The mean 30-day chest pain AUC per session was higher with RFA than h-APC (64.5±56.2 vs 40.5±47.3 VAS-days; P=0.010). Dysphagia burden was low but greater after RFA than after h-APC (21.1±19.4 vs 14.4±17.5 Mellow-Pinkas score(MPS)-days; P=0.043). QoL scores were similar between groups. Esophageal strictures occurred in 6 patients (19.4%) in the RFA group and 1 (3.2%) in the h-APC group. Rates of CR-IM (67.7% vs 71.0%) and CR-D (90.3% in both groups) were comparable.

Compared with RFA, h-APC was associated with a lower postprocedural pain and dysphagia burden and numerically fewer post-ablation strictures, while achieving similar eradication rates of dysplastic Barrett's esophagus.