P1364 - Combining Argon Plasma Coagulation with Radiofrequency Ablation for Therapy of Dysplastic Barrett’s Esophagus Preserves Efficacy While Saving Costs

Talha M. Qureshi, MD, Clark Hair, MD, Gyanprakash A. Ketwaroo, MD
Baylor College of Medicine, Houston, TX

Introduction: Barrett’s esophagus (BE) is a well-established precursor to esophageal adenocarcinoma (EAC). The presence of dysplasia in BE significantly increases the risk of EAC. Current guidelines recommend radiofrequency ablation (RFA) for treatment of dysplastic BE. Patients require an average of 4-5 RFA sessions and it is not uncommon to observe small islands of residual BE after initial RFA sessions. When RFA was first introduced at our tertiary care medical center, these small islands were often treated with APC.

Methods: We performed a quality assurance study to assess the long-term outcomes of the subset of patients treated with combined RFA and APC for dysplastic BE. 950 patients with biopsy confirmed BE from January 2009-February 2019 were reviewed. Patients with low grade dysplasia (LGD) or high grade dysplasia (HGD) who were treated with combined RFA and APC, and had at least one follow up endoscopic surveillance 12 months after the last APC session were included in this QA initiative. We assessed complete eradication of dysplasia (CE-D) and complete eradication of intestinal metaplasia (CE-IM). A per patient cost analysis was also performed.

Results: All patients (n=16) were male with a mean age of 65.1 years. All patients were prescribed a proton pump inhibitor. 56.2% patients had LGD and 43.8% had HGD. The mean BE length was 6.6 cm. A mean of 2.6 ± 1.4 RFA sessions and 1.6 ± 0.6 adjunct APC sessions were performed in this cohort. CE-D was achieved in 100% of patients and CE-IM in 81.2%. There were no buried glands on surveillance biopsies. The mean follow up period after APC completion was 41.3 months. There were 2 cases of major bleeding managed successfully with endoscopic intervention. The average per patient savings was $1,563.

Discussion: We show that a multimodal approach involving RFA and APC is efficacious, safe, and cost effective in achieving high rates of CE-D and CE-IM. The findings in his cohort, and recent studies, encourage future prospective trials evaluating the efficacy and cost-effectiveness of the multimodal approach compared to serial RFA.

Results	n=16
Male (%)	16 (100)
Age (yrs)	65.1
Ethnicity
White	15 (93.7)
Black	1 (6.3)
Tobacco use
Current/former smoker (%)	13 (81.2)
Never smoker (%)	3 (18.2)
Endoscopic ablation
RFA sessions	2.6 ± 1.4
APC sessions	1.6 ± 0.6
Follow up after last APC (mo)	41.3 ± 19.8
Primary endpoints
CE-D (%)	16 (100)
CE-IM (%)	13 (81.2)
Buried glands on surveillance biopsies (%)	0 (0)
Adverse events
Minor bleeding (%)	1 (6.3)
Major bleeding (%)	2 (12.5)
Stricture (%)	0 (0)
Perforation (%)	0 (0)
Per patient savings ($)	1563

Table: Title: Results summary of RFA and adjunctive APC for dysplastic BE

Abbreviations: RFA: Radiofrequency ablation, APC: Argon plasma coagulation, BE: Barrett's esophagus, CE-D: complete eradication of dysplasia, CE-IM: complete eradication of intestinal metaplasia


Disclosures:
Talha Qureshi indicated no relevant financial relationships.
Clark Hair indicated no relevant financial relationships.
Gyanprakash Ketwaroo indicated no relevant financial relationships.


Talha M. Qureshi, MD, Clark Hair, MD, Gyanprakash A. Ketwaroo, MD. P1364 - Combining Argon Plasma Coagulation with Radiofrequency Ablation for Therapy of Dysplastic Barrett’s Esophagus Preserves Efficacy While Saving Costs, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.