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, 1st mucosa ablation (60Watt), removal of tissue remnants by the distal cap, 2nd 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.
