Post written by Truptesh H. Kothari, MD, from the Center for Advanced Therapeutic Endoscopy, Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, New York, United States.

Our case was an elderly patient who had history of Roux-en-y gastric bypass many years ago, now presented to his gastroenterologist for abdominal pain. On upper endoscopy, diffusely spread adenomatous flat lesions were noted at the GJ anastomosis. The patient was deemed not a candidate for surgery and was referred to us for endoscopic treatment.

For such a diffusely spreading lesion, we opted to treat with a new modality called hybrid argon plasma coagulation (hybrid APC). The principal of hybrid APC is to lift the adenomatous mucosal surface by injecting the submucosa with high-pressured methylene blue solution and then ablate the entire area, which is the concern for adenoma. Repeat treatment is performed in a similar fashion. We scoped the patient in 3 months post treatment, and biopsies of the abnormal sites resulted in non-dysplastic mucosa.

Treatment of diffusely spreading foregut lesions, especially at the GJ anastomosis site, is not described in literature with any treatment modality; hence, it is important for gastroenterologists to understand as well as learn of the existence of new modalities and practice them in scenarios as described above.

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