P5135 - Comparative Efficacy and Safety of Hybrid Argon Plasma Coagulation vs Radiofrequency Ablation for Barrett’s Esophagus: A Systematic Review and Meta-Analysis

Khyati Bidani, MD¹, Vishali Moond, MD², Vikash Kumar, MD³, Louisa Recinos-Arenas, MD¹, Andrew Korman, MD¹, Sugirdhana Velpari, MD¹, Arkady Broder, MD, FACG¹
1Saint Peter's University Hospital / Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; 2Saint Peter's University Hospital/Robert Wood Johnson Medical School loc, New Brunswick, NJ; 3Creighton University School of Medicine, Phoenix, AZ

Introduction: Radiofrequency ablation (RFA) has long been the standard endoscopic therapy for dysplastic Barrett’s esophagus (BE). Recently, hybrid argon plasma coagulation (H-APC)—a technique combining submucosal fluid cushioning with APC—has emerged as a promising alternative with potentially improved safety and efficacy profiles. This study aims to systematically evaluate and compare the pooled clinical outcomes and safety of H-APC versus RFA in the treatment of Barrett’s esophagus.

Methods: A comprehensive literature search was conducted across Medline, Embase, PubMed, Cochrane Library, Web of Science, and major conference proceedings through May 2025. Studies reporting outcomes for H-APC or RFA in BE were included. The primary outcomes were histologic remission, complete eradication of intestinal metaplasia (CE-IM), and complete eradication of dysplasia (CE-D). Secondary outcomes included recurrence rates, overall adverse events, and stricture formation. Meta-analyses were performed using a random-effects model, and heterogeneity was assessed using I² statistics.

Results: A total of 16 studies were included in the analysis (H-APC: 8 studies; RFA: 8 studies). H-APC demonstrated higher rates of histologic remission (92.2% [95% CI: 86.1%–95.8%]; I² = 71%) compared to RFA (81.3% [74.9%–86.3%]; I² = 42%), though this difference was not statistically significant (p = 0.09). CE-IM was significantly higher with H-APC (91.6% [85.3%–95.4%]; I² = 73%) than with RFA (82.2% [77.9%–85.7%]; I² = 42%; p = 0.014). CE-D rates were also significantly greater with H-APC (99.5% [97.6%–99.9%]; I² = 0%) compared to RFA (91.1% [87.8%–94.7%]; I² = 56%; p = 0.01). Recurrence rates were comparable (H-APC: 9.3% vs. RFA: 8.0%; p = 0.79). However, H-APC had significantly fewer overall adverse events (4.9% vs. 20.9%; p = 0.04) and strictures (1.9% vs. 8.0%; p = 0.00). (table 1)

Discussion: Hybrid APC appears to be an effective and safer alternative to RFA for the management of Barrett’s esophagus, with superior rates of CE-IM and CE-D and significantly lower rates of adverse events and strictures. These findings support the expanding role of H-APC as a frontline therapy for BE, though prospective head-to-head trials are warranted to validate long-term comparative outcomes.


Figure: Table 1: Outcomes of HAPC vs RFA


Disclosures:
Khyati Bidani indicated no relevant financial relationships.
Vishali Moond indicated no relevant financial relationships.
Vikash Kumar indicated no relevant financial relationships.
Louisa Recinos-Arenas indicated no relevant financial relationships.
Andrew Korman indicated no relevant financial relationships.
Sugirdhana Velpari indicated no relevant financial relationships.
Arkady Broder indicated no relevant financial relationships.

Khyati Bidani, MD¹, Vishali Moond, MD², Vikash Kumar, MD³, Louisa Recinos-Arenas, MD¹, Andrew Korman, MD¹, Sugirdhana Velpari, MD¹, Arkady Broder, MD, FACG¹. P5135 - Comparative Efficacy and Safety of Hybrid Argon Plasma Coagulation vs Radiofrequency Ablation for Barrett’s Esophagus: A Systematic Review and Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.