Argon plasma coagulation, endoscopic mucosal resection, and endoscopic submucosal dissection for gastric low-grade dysplasia: a multicenter inverse probability–weighted cohort study

Background: Argon plasma coagulation (APC) has been proposed for the treatment of gastric low-grade dysplasia (LGD), but comparative data with endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are insufficient. We investigated the clinical outcomes of APC, EMR, and ESD for small gastric LGD. Methods: We retrospectively included 2128 patients treated with APC (n = 799), EMR (n = 404), or ESD (n = 925) for gastric LGD ≤ 20 mm at 12 tertiary centers in Korea between 2017 and 2021. Local recurrence and adverse events (AEs) were evaluated. To minimize selection bias, inverse probability of treatment weighting (IPTW) was applied. Results: The overall incidence of AEs was significantly lower in the APC group (0.8%) than in the EMR (2.7%) and ESD (3.6%) groups (P < 0.001). Local recurrence occurred in 30 patients (3.8%) treated with APC during a median follow-up of 28.8 months, which was significantly higher than that in the EMR (0.2%) and ESD (0.8%) groups (P < 0.001). Among lesions measuring ≤ 10 mm, AEs occurred in 0.4%, 2.6%, and 3.3% after APC, EMR, and ESD, respectively (P < 0.001), whereas local recurrence developed in 2.2%, 0.0%, and 0.6%, respectively (P = 0.002). IPTW analyses yielded results consistent with the unweighted analyses. Conclusions: This large multicenter study showed that APC is associated with a higher risk of local recurrence than EMR or ESD but a lower AE rate. APC may be considered a safe and practical treatment option for selected patients with gastric LGD ≤ 10 mm.