Abstract
Introduction: The palliative effect of endoscopic thermal techniques (Nd:Yag-laser, APC) for the treatment of obstructing gastrointestinal (GI) tumors has been proven for years. APC is a thermal coagulation technique that uses ionized argon to transmit high-frequency electrical current, contact free, to tissue. However, data from the new APC -VIO -300D -system with amplified power settings and different application modes is lacking. The aim of the study was to compare the new mode of PULSED APC (10 argon beams/sec.) vs. the well-known FORCED APC mode. Methods: Patients (pts.) with symptomatic obstructing tumors of esophagus, stomach and rectum were enrolled in the study. The palliative effect was assessed by evaluating the size of the restored lumen (1/3, 2/3, complete restoration), length of the stenosis (cm), and time and number of APC-sessions. The range of energy output was 40-130 Watt (median FORCED 83 Watt; median PULSED 76 Watt). A total number of 83 pts. were included (FORCED 44 pts., PULSED 39 pts.). Results: The overall response rate after treatment was 87% (38/44 pts.) with FORCED APC vs. 83% (32/39 pts) with PULSED APC. Complete restoration of the lumen: FORCED APC 16% (7/44) vs. PULSED APC 9% (3/39). Restoration >2/3 of the lumen: FORCED APC 55% (24/44) vs. PULSED APC 52% (20/39). Restoration >1/3 of the lumen: FORCED APC 16% (7/44) vs. PULSED APC 23% (9/39). Restoration of the lumen <1/3 was seen in 13.6% (FORCED APC) vs. 18% (PULSED APC). The median length of the tumors was shortened with FORCED APC by 2.4 cm and with PULSED APC by 2.5 cm. Overall, a median number of 2.2 treatment sessions were necessary (FORCED APC 2.0, PULSED APC 2.6). The tumor debulking effect was achieved in a significantly shorter median application time (in minutes) with FORCED APC (FORCED APC 13 min. vs. PULSED APC 19.5 min.) (p = 0.03). Major complications occurred in 10.5% of pts. with FORCED APC vs. 7% of pts. with PULSED APC. Conclusion: There was no significant difference in overall local tumor response and major complication rate between the modes. However, the local palliative response was achieved significantly earlier with FORCED APC. Therefore high-energy APC (>70 Watt) with the VIO -300D -system could become an alternative option to established thermal vaporization techniques in obstructing GI-tumors.
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