HYBRID-APC FOR THE ENDOSCOPIC ERADICATION OF DYSPLASTIC BARRETT'S ESOPHAGUS IN A LOW PREVALENCE COUNTRY: LONG-TERM RESULTS OF THE TREATMENT AFTER THE ONSITE TRAINING

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Aims: This study was undertaken to evaluate the efficacy and safety of Hybrid-APC for the treatment of dysplastic BE in a low prevalence country after the onsite training. Methods: All procedures were performed by a single operator (SK) after the onsite training by an experienced endoscopist (HM). Hybrid-APC was performed by the hybrid APC probe with water jet system (ERBE, Germany) in 5 steps: marking, submucosal injection, 1 st mucosa ablation (60Watt), removal of tissue remnants by the distal cap, 2 nd ablation with the lower power (40Watt). High dose PPI was administered after the procedures. After complete BE eradication endoscopy with 4-quadrant biopsies from former BE segment was performed in 3, 6 months and then annually. All histology specimens were estimated by an experienced gastrointestinal pathologist. Results: From 120 BE patients (registered from July 2014 to September 2017) 11 patients (5 male, 6 female, mean age 46 years (range 25 – 63)) were diagnosed with dysplasia and treated with Hybrid-APC. The mean length of BE was C1M2. In five cases EMR was performed for visible lesions before ablation. Eighteen Hybrid-APC sessions were successfully performed. Complete BE eradication was achieved after a mean of 1.6 (range 1 – 3) sessions. No perforation or uncontrollable bleeding was detected. Stricture formation was observed in one patient after combination therapy with Hybrid-APC and EMR in the one session and was managed by balloon dilatation. The patients were followed-up for a mean of 3.1 years (range 17 – 53 months) after BE eradication. Neither recurrence of intestinal metaplasia, nor buried intestinal metaplasia was seen in any patients. Conclusions: Our study demonstrated high effectiveness and safety of Hybrid-APC for treatment of dysplastic BE. 3-year follow-up didn't reveal any recurrence, buried metaplasia or any major complications. Since Hybrid-APC is an operator dependent technique our data emphasizes the importance of a proper training to provide reliable long-term outcomes.

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