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Background <p>Gastric mucosal ablation (GMA) using hybrid argon plasma coagulation (hAPC) is an investigational endoscopic technique that selectively devitalizes ghrelin-producing gastric mucosa to modulate appetite-regulating pathways. As clinical investigation extends beyond early trials, a standardized safety framework is needed to support responsible implementation.</p> Methods <p>An international panel of investigators with direct procedural experience in GMA (&gt; 300 procedures collectively) developed consensus safety recommendations using a modified Delphi process. Formal systematic review with GRADE assessment was not undertaken, as the nascent evidence does not support such evaluation. Consensus was defined as ≥ 75% agreement among panelists. Recommendations were classified by consensus strength (high ≥ 80%, moderate 60–79%, low 51–59%) reflecting the degree of panel agreement rather than formal certainty of evidence.</p> Results <p>The panel identified nine procedural and post-procedural domains important for the safe execution of GMA. These include: (1) cold saline submucosal injection to elevate the mucosa; (2) ablation precisely confined to the elevated zone; (3) ablation limited to 5&#xa0;mm from the edge of each fluid cushion; (4) APC energy delivery limited to ≤ 40&#xa0;W; (5) judicious evacuation of argon gas throughout the procedure; (6) high-dose proton pump inhibitor therapy for a minimum of four weeks; (7) sucralfate for four weeks; (8) gradual post-procedure dietary advancement; and (9) operator credentialing, including proctoring until proficiency is demonstrated.</p> Conclusions <p>This consensus-driven framework for GMA provides preliminary safety guidance for clinical investigation and may serve as a model for other emerging endoscopic metabolic therapies.</p>

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Safety Framework for Gastric Mucosal Ablation (GMA) Using Hybrid Argon Plasma Coagulation (hAPC): International Expert Consensus

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月16日

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  • Vivek Kumbhari,
  • Adrian Sartoretto,
  • Ivo Boskoski,
  • Diogo de Moura,
  • Dilhana Badurdeen,
  • Daniel Maselli,
  • Eduardo de Moura,
  • Valerio Pontecorvi,
  • Barham Abu Dayyeh,
  • Christopher McGowan

摘要

Background

Gastric mucosal ablation (GMA) using hybrid argon plasma coagulation (hAPC) is an investigational endoscopic technique that selectively devitalizes ghrelin-producing gastric mucosa to modulate appetite-regulating pathways. As clinical investigation extends beyond early trials, a standardized safety framework is needed to support responsible implementation.

Methods

An international panel of investigators with direct procedural experience in GMA (> 300 procedures collectively) developed consensus safety recommendations using a modified Delphi process. Formal systematic review with GRADE assessment was not undertaken, as the nascent evidence does not support such evaluation. Consensus was defined as ≥ 75% agreement among panelists. Recommendations were classified by consensus strength (high ≥ 80%, moderate 60–79%, low 51–59%) reflecting the degree of panel agreement rather than formal certainty of evidence.

Results

The panel identified nine procedural and post-procedural domains important for the safe execution of GMA. These include: (1) cold saline submucosal injection to elevate the mucosa; (2) ablation precisely confined to the elevated zone; (3) ablation limited to 5 mm from the edge of each fluid cushion; (4) APC energy delivery limited to ≤ 40 W; (5) judicious evacuation of argon gas throughout the procedure; (6) high-dose proton pump inhibitor therapy for a minimum of four weeks; (7) sucralfate for four weeks; (8) gradual post-procedure dietary advancement; and (9) operator credentialing, including proctoring until proficiency is demonstrated.

Conclusions

This consensus-driven framework for GMA provides preliminary safety guidance for clinical investigation and may serve as a model for other emerging endoscopic metabolic therapies.