S1311 Comparative Efficacy and Safety of Hybrid Argon Plasma Coagulation vs Radiofrequency Ablation for Barrett’s Esophagus: A Systematic Review and Meta-Analysis

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). Conclusion: 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.