Radiofrequency ablation versus hybrid argon plasma coagulation in Barrett's esophagus: a prospective randomised trial.

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.

Bile acid sequestrants in poor healing after endoscopic therapy of Barrett's esophagus.

BACKGROUND/AIMS: Endoscopic therapy for neoplastic Barrett's esophagus (BE) has become the standard of care over the past two decades. In clinical practice, we regularly encounter patients who fail to achieve complete squamous epithelialization of the esophagus. Although the therapeutic strategies in the individual stages of BE, dysplasia, and esophageal adenocarcinoma are well studied and largely standardized, the problem of inadequate healing after endoscopic therapy is only marginally considered. This study aimed to shed light on the variables influencing inadequate wound healing after endoscopic therapy and the effect of bile acid sequestrants (BAS) on healing. METHODS: Retrospective analysis of endoscopically treated neoplastic BE in a single referral center. RESULTS: In 12.1% out of 627 patients, insufficient healing was present 8 to 12 weeks after previous endoscopic therapy. The average follow-up duration was 38.8±18.4 months. Complete healing was achieved in 13 patients already after intensifying proton pump inhibitor therapy. Out of 48 patients under BAS, 29 patients (60.4%) showed complete healing. An additional eight patients (16.7%) improved, but only partial healing was achieved. Eleven (22.9%) patients showed no response to BAS augmented therapy. CONCLUSION: In cases of insufficient healing even under exhaustion of proton pump inhibitors, treatment with BAS can be an option as an ultimate healing attempt.

Non-thermal ablation of non-neoplastic Barrett's esophagus with the novel EndoRotor® resection device.

BACKGROUND: International guidelines suggest endoscopic resection for all patients with low-risk mucosal cancer. Ultimately, it is essential to treat the remaining Barrett's esophagus as part of the treatment. Different thermal ablative therapies have been implemented to effect this treatment. They can lead to potential post-therapeutic stenosis. Furthermore, a histologic assessment of treated mucosa is not possible. OBJECTIVE: Clinical evaluation of a novel, non-thermal resection device (EndoRotor®) in the treatment of non-neoplastic Barrett's esophagus was conducted. METHODS: Fourteen patients with early Barrett's carcinoma were treated with endoscopic resection. Subsequently, EndoRotor® therapy was performed for resection of the remaining Barrett's mucosa. Complications were assessed during the study. After a three-month period patients received follow-up endoscopy to evaluate post-therapeutic stenosis. RESULTS: On average, 674 mm2 (172 mm2 - 1600 mm2) of Barrett's mucosa was treated with the novel device. In six (37.5%) cases, intra-procedural bleeding occurred with the need for hemostasis. All bleeding could be managed by endoscopic therapy alone. After a three-month follow-up there was no post-therapeutic stenosis registered. CONCLUSION: EndoRotor® resection is a feasible non-thermal treatment of non-neoplastic Barrett's esophagus. Larger trials have to evaluate risks and benefits of this novel device.