In a prospective randomized trial, researchers have pitted two established thermal ablation techniques, radiofrequency ablation (RFA) and hybrid argon plasma coagulation (H-APC), against each other in the quest to find the most effective treatment for managing Barrett's esophagus following endoscopic resection. Following endoscopic resection, volunteers were randomly allocated to either H-APC or RFA.

The H-APC technique applied a simplified approach at 60 W, while RFA utilized a 90° focal catheter with a simplified protocol of 12 J/cm2 × 3 or a Halo 360° balloon with 10 J/cm2 per cleaning cycle. The study meticulously recorded eradication rates and adverse events, with patients undergoing follow-up examinations at 3, 6, 12, and 24 months. The study, encompassing 101 patients (47 in the RFA group, 54 in the H-APC group), revealed compelling insights. After a median follow-up period of 21 months, the long-term eradication rates were slightly higher in the H-APC group than RFA group (Table 1).

Notably, post-interventional pain emerged as a significant differentiator, with the RFA group experiencing a mean score of 4.56/10 lasting 7.54 days, compared to the H-APC group's mean score of 2.07/10 over 3.59 days. Stenoses requiring intervention were observed in 3.7% of the H-APC arm and 14.9% in the RFA arm. Therefore, both ablation techniques yielded commendable results in terms of eradication rates, with a slight edge favoring H-APC.

However, the RFA group displayed considerably greater post-interventional pain in terms of both severity and duration. These findings provide critical insights for clinicians and patients alike, emphasizing the delicate balance between effectiveness and patient comfort in choosing the optimal treatment for Barrett's esophagus.