Abstract
Background and aims
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.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).Results
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.Conclusions
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.