Endoscopic Radiofrequency Ablation Versus Hybrid Argon Plasma Coagulation in the Treatment of Barrett's Esophagus

Endoscopic Radiofrequency Ablation Versus Hybrid Argon Plasma Coagulation in the Treatment of Barrett's Esophagus - the Patients' Perspective: a Randomized Controlled Trial Assessing Procedural Acceptability and Safety (RATE Study)

This study compares patients' acceptability and safety of two established endoscopic methods for treating dysplastic Barrett's esophagus: radiofrequency ablation versus hybrid argon plasma coagulation.

Both endoscopic radiofrequency ablation (RFA) and argon plasma coagulation (APC) are established treatment modalities for dysplastic Barrett's esophagus. Recently, a modification of the APC method has emerged, which involves a submucosal injection of saline preceding the thermal ablation (hybrid-APC; h-APC). This allows to increase the procedure's safety and presumably reduces the patients' post-procedural discomfort. Although both RFA and h-APC are characterized by high effectiveness in eradicating Barrett's segments, limited data compares the patient-related aspects of the procedures. To fill this knowledge gap, we set out a single-center randomized-controlled trial to compare procedural acceptability, safety, and impact on the quality of life, of the two methods.

Inclusion Criteria:

• Male or female subjects over 18 years
• Histologically and endoscopically proven Barrett's esophagus requiring ablation therapy according to the current guidelines
• General health status sufficient to perform an endoscopic procedure (ASA I-III)

Exclusion Criteria:

• Primary or secondary coagulopathy, with INR>1.5 and/or platelet count of <75,000.
• Anticoagulation therapy (e.g. warfarin) for high-risk condition and unable to withhold the medication temporarily
• Recent myocardial infraction or other significant cardiovascular event within 6 months prior to recruitment
• Patients under long-term care and/or within nursing facilities (e.g. psychosocial disorders, mental retardation)
• Any history of esophageal resection surgery
• Esophageal varices