Endoscopic foregut surgery and interventions: The future is now. The state-of-the-art and my personal journey

Figure 19 Hybrid argon plasma coagulation to treat residual diffuse, multi-focal Barrett’s after endoscopic submucosal dissection for early esophageal cancer. A: Endoscopic view of multiple residual Barrett’s islands; B: Needle-free high pressure water jet to create saline cushion in the submucosal space; C: Pass 1 of argon plasma coagulation (APC) ablation with energy settings of Pulsed APC flow rate 0.8 L/min 60 W; endoscopic submucosal dissection (ESD) cap used for visibility, traction and maintaining precise focal distance for even application; D: Completion of Pass 1; E: Repeat water jet into submucosa; F: Pass 2 of APC ablation with energy settings of pulsed APC flow rate 0.8 L/min 40 W; G: Completion of Pass 2 with desired tan colored surface; H: Follow-up endoscopy 6 months post hybrid APC treatment, with biopsy and WATS brushing confirming complete response of intestinal metaplasia.