Argon beam plasma coagulation in the management of cancers of the esophagus and stomach.

Abstract

Esophagogastric cancer often presents at an advanced stage, or in patients unfit for resection. These patients may benefit from local ablation to provide both symptom and disease control. A series of 48 consecutive patients with esophagogastric cancer were treated with endoscopic argon beam plasma coagulation (ABPC) at a specialist unit. Of 16 unfit patients who presented with early cancers, four are disease-free and all are asymptomatic at a median of 21 months after treatment. In 13 of 14 patients with occluded esophageal stents, the esophageal lumen was restored. In 18 patients with advanced cancers, ABPC was employed to debulk two gastric outlet and eight esophageal tumors. Argon was employed successfully to control bleeding in three of five patients. In advanced disease, dysphagia was relieved in only one of three patients. Endoscopic ABPC controls symptoms and may control early esophageal and gastric cancers in unfit patients. ABPC allows restoration of the lumen in stent overgrowth and control of bleeding from advanced gastric neoplasms; however, its role in debulking large tumors is less clear.