Radiofrequency ablation versus hybrid argon plasma coagulation for dysplastic Barrett's esophagus: a randomized-controlled trial assessing procedural tolerability and safety (RATE study)
In brief
Hybrid argon plasma coagulation cuts chest-pain burden by 37% versus RFA
In a single-center randomized trial involving 62 patients, hybrid argon plasma coagulation was linked to 37% less chest-pain burden over 30 days than radiofrequency ablation, with less dysphagia and similar rates of Barrett's tissue and dysplasia eradication. Strictures occurred in 1 patient after hybrid treatment versus 6 after radiofrequency ablation, but the trial was small, so the safety difference needs confirmation.
- Journal
- Gastrointestinal endoscopy (Q1)
- Published
- 30 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Robert Klimkowski, Nastazja D Pilonis, Ewa Wronska, Andrzej Mroz, Malgorzata Lenarcik, Jaroslaw Regula, et al.
- PMID
- 42815697
- DOI
- 10.1016/j.gie.2026.09.040
Why clinicians should know about it
- Picked for Gastroenterology (paper of the day, 1 October 2026): h‑APC reduces pain, similar eradication rates in dysplastic BE
Abstract
BACKGROUND AND AIMS: Radiofrequency ablation (RFA) is the mainstay endoscopic therapy for dysplastic Barrett's esophagus (BE) but is frequently associated with postprocedural pain and dysphagia. Hybrid argon plasma coagulation (h-APC) may reduce thermal injury while maintaining efficacy. We aimed to compare procedure-related symptom burden, safety, and effectiveness of these two methods. METHODS: In this single-center, randomized-controlled trial, patients with dysplastic BE were randomized 1:1 to receive RFA or h-APC. The primary endpoint was 30-day postprocedural chest-pain burden per ablation, defined as the area under the curve (AUC) of 0-10 visual analog scores (VAS) obtained immediately post-procedure, at day 7, and at day 30. Secondary endpoints included dysphagia burden, esophageal-specific quality of life (QoL), adverse events, procedure duration, and rates of complete remission of intestinal metaplasia (CR-IM) and dysplasia (CR-D). RESULTS: In total, 129 ablation sessions (67 RFA, 62 h-APC) in 62 patients were analyzed. The mean 30-day chest pain AUC per session was higher with RFA than h-APC (64.5±56.2 vs 40.5±47.3 VAS-days; P=0.010). Dysphagia burden was low but greater after RFA than after h-APC (21.1±19.4 vs 14.4±17.5 Mellow-Pinkas score(MPS)-days; P=0.043). QoL scores were similar between groups. Esophageal strictures occurred in 6 patients (19.4%) in the RFA group and 1 (3.2%) in the h-APC group. Rates of CR-IM (67.7% vs 71.0%) and CR-D (90.3% in both groups) were comparable. CONCLUSIONS: Compared with RFA, h-APC was associated with a lower postprocedural pain and dysphagia burden and numerically fewer post-ablation strictures, while achieving similar eradication rates of dysplastic Barrett's esophagus.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.