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As clinical investigation extends beyond early trials, a standardized safety framework is needed to support responsible implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An international panel of investigators with direct procedural experience in GMA (&gt;\u2009300 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 \u2265\u200975% agreement among panelists. Recommendations were classified by consensus strength (high\u2009\u2265\u200980%, moderate 60\u201379%, low 51\u201359%) reflecting the degree of panel agreement rather than formal certainty of evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats: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\u00a0mm from the edge of each fluid cushion; (4) APC energy delivery limited to \u2264\u200940\u00a0W; (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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats: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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11695-026-08685-3","type":"journal-article","created":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T13:20:36Z","timestamp":1778937636000},"page":"3586-3597","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Safety Framework for Gastric Mucosal Ablation (GMA) Using Hybrid Argon Plasma Coagulation (hAPC): International Expert Consensus"],"prefix":"10.1007","volume":"36","author":[{"given":"Vivek","family":"Kumbhari","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Sartoretto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivo","family":"Boskoski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diogo","family":"de Moura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dilhana","family":"Badurdeen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Maselli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"de Moura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerio","family":"Pontecorvi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barham","family":"Abu Dayyeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"McGowan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,16]]},"reference":[{"key":"8685_CR1","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1007\/s11695-021-05773-4","volume":"32","author":"MI Itani","year":"2022","unstructured":"Itani MI, Oberbach A, Salimian KJ, Enderle M, Hahn H, Abbarh S, et al. 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This consensus statement synthesizes previously published data from studies that received appropriate institutional review board approval at their respective institutions.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}},{"value":"For this type of study, formal consent is not required.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed Consent"}},{"value":"Vivek Kumbhari has received consulting fees and research support from Erbe Elektromedizin GmbH. Ivo Boskoski is a consultant for Erbe Elektromedizin GmbH. Adrian Sartoretto is a consultant for Erbe Elektromedizin GmbH. Barham Abu Dayyeh has received consulting fees from Erbe Elektromedizin GmbH. Christopher McGowan has received research funding and consulting fees from Erbe Elektromedizin GmbH. All other authors have no conflicts to declare.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}