3558 Argon plasma coagulation for eradication of esophageal varices after treatment with endoscopic variceal banding ligation or sclerotherapy.

Abstract

Background: Endoscopic variceal banding ligation (EVL) and sclerotherapy (EVS) have been used to prevent variceal hemorrhage. However, the rate of recurrence of esophageal varices after EVL or EVS is considerably high. Argon plasma coagulation (APC) is a new modality of electrosurgery to apply high frequency electric current into tissue to cause defined thermal effects. This study was conducted to determine whether APC is beneficial for eradication of residual esophageal varices after EVL or EIS. Methods: Cirrhotic patients with endoscopically assessed high-risk esophageal varices but no history of bleeding underwent EVL or EIS to reduce the risk of hemorrhage. When the size of varices was reduced 1 week later, the entire esophageal mucosae 4-5 cm proximal to the esophagogastric junction was coagulated with one session of APC in a total of 15 patients.APC was performed with the use of argon source APC300 and high frequency generator ICC 200 (ERBE, Germany). Follow-up endoscopy was performed 7 days and 1 month after the initial procedure and thereafter every 3 months, to check for recurrent/residual esophageal varices and its complications. Results: Ten to 14 days after APC, ulcerations with white coating were noted in all cases, whereas varices were completely eradicated. One month after APC, while the varices remained eradicated, coagulated esophageal mucosae became whitish and the ulcerations were nearly completely healed. During the course, no patients complained of dysphagia or retrosternal pain. Furthermore, neither development of gastric varices nor aggravation of portal hypertensive gastropathy was observed endoscopically. No serious complication such as bleeding necessitating endoscopic therapy and perforation or stricture of the esophagus was encountered. Over a maximum follow-up period of 5 months, neither recurrence of nor hemorrhage from esophageal varices was observed. Conclusions: APC ablation of residual esophageal varices in patients who have undergone prior EVL or EIS is safe and may be a novel approach to eradicate esophageal varices. It requires a long term follow-up of the eradicated varices to further evaluate its efficacy.