Argon Plasma Coagulation Therapy Research Articles

Comparing the effects of argon plasma coagulation and interferon therapy in patients with vaginal intraepithelial neoplasia: a single-center retrospective study.

This study aimed to evaluate the clinical efficacy and safety of argon plasma coagulation (APC) therapy and interferon therapy in patients with grade I and II vaginal intraepithelial neoplasia (VaIN). A total of 112 patients with VaIN were diagnosed via colposcopy-induced biopsy and classified into the APC group (n = 77) and interferon group (n = 35). Clinical data including age, grade, symptoms, historical or concomitant neoplasia of the lower genital tract, indications for hysterectomy, pregnancy history, cytology, human papillomavirus (HPV) subtype, treatment modalities, and clinical outcomes were analyzed, retrospectively. Complications and clinical outcomes were assessed at 6- and 12-month follow-ups. There was no significant difference in the HPV clearance rate between the APC (53.42%) and interferon (33.33%) groups at 6 months after treatment. However, the 12-month follow-up of the APC group showed a significantly higher HPV clearance rate as compared to the interferon group (87.67% vs. 51.52%, P < 0.05). The APC group exhibited a significantly higher cure rate (79.22% vs. 40.0%) and lower persistence rate (12.99% vs. 37.14%) than the interferon group (P < 0.05). Adverse reaction analysis revealed that the primary reaction in the APC group was vaginal drainage, in contrast to the increased vaginal discharge in the interferon group; though the difference was significant (68.83% vs. 28.57%, P < 0.05), no serious complications were observed. Treatment with APC is a safe and more effective procedure against VaIN I and II, compared to interferon. APC may serve as a viable alternative to other physiotherapies.

ROUX-EN-Y GASTRIC BYPASS POUCH OUTLET REDUCTION USING ARGON PLASMA COAGULATION

Background and study aims A comparative study was conducted to evaluate the efficacy of argon plasma coagulation (APC) therapy in treating post Roux-en-Y gastric bypass (RYGB) weight regain and the incidence of complications related to this procedure, using a sham treatment group as a control. Patients and methods Forty-one patients with a minimum weight regain of 10 kg and a minimum postoperative time of 36 months were randomized into two groups. Results In the APC group (n = 21), the mean initial weight was 100.4 kg and the mean weight regain was 24.94 kg. In the sham group (n = 20), the mean initial weight was 103.65 kg, and the mean weight regain was 25.18 kg. Anastomotic stenosis occurred only after the first APC session. The results for the comparison of APC with the sham group showed a percentage weight regain loss of 63.95 compared to -.65, and weight loss of 15.02 and -0.57), percentage total weight loss of 14.46 and -0.62, excess weight loss of 54.32 % and -2.34 %), and BMI reduction of 5.38 and -0.21, with P < 0.0001 for all the comparisons. In the APC group, there was a significant reduction in HbA1c (5.66 % to 4.96 %) and triglycerides (153.20 mg/dL to 132.20 mg/dL). Conclusions This study indicates that APC outlet pouch reduction outperforms sham treatment in terms of weight loss for patients presenting weight regain after RYGB.

Argon plasma coagulation therapy in hemorrhagic radiation proctitis following pelvic radiation in gynecological malignancies.

Chronic radiation proctitis is a common chronic complication of malignant pelvic diseases after pelvic radiation therapy. Although, the incidence has decreased after advent of intensity-modulated radiotherapy due to better control of radiation dose to rectum. In the era of conventional two-field radiotherapy to pelvis, this was a common complication usually presenting after 1-2 years of treatment completion. Rectal bleeding caused by radiation proctitis is difficult to manage. Argon plasma coagulation (APC) is an electrocoagulation technique that appears to be an effective and low-cost alternative to the use of lasers in gastrointestinal endoscopy. The aim of this study was to evaluate the efficacy of APC, as well as patients' tolerance of the procedure, in the treatment of bleeding radiation-induced proctitis. Between January 2015 and August 2017, 29 patients of cancer cervix treated with definite radiotherapy both external and brachytherapy who suffered from rectal bleeding due to radiation proctitis were included for treatment with argon plasma laser (APC). Twenty-three patients suffered from anemia, 16 of whom required blood transfusion. APC was performed, applying the no-touch spotting technique at an electrical power of 40 Watt and an argon gas flow of 1.5-2.0 l/min. Pulse duration was <0.5 s. Treatment sessions were carried out at intervals of 3 weeks. Subjects received 2-4 treatment sessions. Twenty-eight out of 29 patients were accessible for effects and results. APC led to persistent clinical and endoscopic remission of rectal bleeding after a median of three sessions. No adverse effects were encountered after initial treatment. All the patients were in complete remission. APC is an effective, safe, and well-tolerated treatment for rectal bleeding caused by chronic radiation proctitis. It should be considered as a first-line therapy for radiation proctitis.

Good Clinical Practices on Argon Plasma Coagulation Treatment for Weight Regain Associated with Dilated Gastrojejunostomy Following Roux-en-Y Gastric Bypass: a Brazilian-Modified Delphi Consensus.

IntroductionArgon plasma coagulation (APC) alone is effective and safe at treating weight regain following Roux-en-Y gastric bypass (RYGB). However, technical details of the treatment vary widely among studies. Therefore, we aimed to create good clinical practice guidelines through a modified Delphi consensus, including experts from the collaborative Bariatric Endoscopy Brazilian group.MethodsForty-one locally renowned experts were invited to the consensus by email. Experiences of > 150 APC-treated cases or authorship of relevant articles were the eligibility criteria. An initial questionnaire with short-answer questions was distributed to the experts. The organizing committee converted the responses into statements for an online 2-day voting webinar. Consensus was defined as more than 67% of positive answers. Three consecutive voting rounds were planned with discussion and statement refinements between rounds.ResultsThirty-seven experts fulfilled eligibility criteria and attended the live webinar voting. The total number of patients treated by the panel was 12,349. By the third round, all 79 statements reached consensus. The recommendations include the definition of dilated gastrojejunal anastomosis as ≥ 15 mm, minimum regain of 20% of the lost weight to indicate the APC therapy, 6 to 8 weeks as the ideal interval between ablation sessions, and stopping treatment when the stoma reaches < 12 mm of breadth.ConclusionsThis consensus provides several recommendations based on a highly experienced panel of endoscopists. Although it covers most aspects of the treatment, the level of evidence is low for the majority of the statements. Therefore, bariatric endoscopists should be constantly attentive to new evidence on APC treatment.Graphical abstract Supplementary InformationThe online version contains supplementary material available at 10.1007/s11695-021-05795-y.

Long-term follow-up in patients with gastric antral vascular ectasia (GAVE) after treatment with endoscopic band ligation (EBL).

Background and study aims Gastric antral vascular ectasia (GAVE) is a capillary-type vascular malformation of the gastric antrum, usually diagnosed endoscopically in patients presenting with iron deficiency anemia or gastrointestinal bleeding. While there is established evidence for treatment with thermal modalities, such as argon plasma coagulation (APC) therapy, more recent studies have shown endoscopic band ligation (EBL) to be safe and effective in achieving remission. Our study aimed to evaluate long-term outcomes of patients with GAVE who underwent EBL at our institution. Patients and methods We retrospectively reviewed data from 33 patients with GAVE who underwent esophagogastroduodenoscopy and EBL between September 2012 and July 2017 within our institution, looking primarily at clinical response, recurrence, and blood transfusion requirements. Results Clinical response was achieved in 27 patients (81.8%). Among responders, recurrence-free survival decreased with time from 88 % at 1 year to 44 % at 2 years. Thirteen patients (48.1 %) had recurrence of GAVE at a mean time of 18.2 months (range 4.7 – 51.8). The only predictor of recurrence was greater number of pre-procedure blood transfusions. Conclusion This is the first study to evaluate long-term response and recurrence in patients with GAVE after treatment with EBL and predictors of clinical response after initial endoscopic therapy have been identified. While we were able to demonstrate excellent remission achievement rates in our GAVE patients who had undergone EBL, close clinical follow-up is clearly required as almost 50 % will have recurrence at around 18 months.

Endoscopic management of esophageal cancer.

Esophageal cancer (EC) generally consists of squamous cell carcinoma (which arise from squamous epithelium) and adenocarcinoma (which arise from columnar epithelium). Due to the increased recognition of risk factors associated with EC and the development of screening programs, there has been an increase in the diagnosis of early EC. Early EC is amenable to curative therapy by endoscopy, which can be performed by either endoscopic resection or endoscopic ablation. Endoscopic resection consists of either endoscopic mucosal resection (preferred in cases of adenocarcinoma) or endoscopic submucosal dissection (preferred in cases of squamous cell carcinoma). Endoscopic ablation can be performed by either radiofrequency ablation, cryotherapy, argon plasma coagulation or photodynamic therapy, amongst others. Endoscopy can also assist in the management of complications post-esophageal surgery, such as anastomotic leaks and perforations. Finally, there is a growing role for endoscopy to manage end-of-life palliative symptoms, especially dysphagia. The growing use of esophageal stents, debulking therapy and dilation can assist in improving a patient’s quality of life. In this review, we examine the multiple roles of endoscopy in the management of patients with EC.

1940 Acute Lower Gastrointestinal Bleeding Due to Multiple Colonic Polypoid Angiodysplasias in a Patient With Sickle Cell Disease

INTRODUCTION: In patients with Sickle Cell Disease who present with hematochezia, ischemic colitis is often identified as the precipitating etiology. Angiodysplasia in sickle cell is infrequently described as the cause of hematochezia, especially in young patients. Our case illustrates the unusual finding of hematochezia due to multiple polypoid angiodysplasias distributed in the entire colon of a young patient with sickle cell disease. CASE DESCRIPTION/METHODS: A 26-year-old male with sickle cell disease leading to cirrhosis decompensated by ascites presented with multiple episodes of painless hematochezia for one day. On physical examination, he was noticed to have relative hypotension, with ascites and bright red blood on rectal exam.His initial lab work noted a hemoglobin level of 4.3 g/dL and an INR of 5.3. As he presented with hematochezia and hypotension, he underwent a computed tomography (CT) scan with intravenous contrast, which showed a blush of contrast at the splenic flexure, indicating an active luminal hemorrhage (Figure 1). However, emergent mesenteric angiography was unsuccessful in detecting active bleeding, thus, embolization could not be performed. A subsequent colonoscopy revealed 11 actively bleeding polypoid angiodysplasias distributed throughout the entire colon (Figures 2 and 3), each treated with argon plasma coagulation and clipping to prevent further bleeding. The patient did not have any recurrent episodes of bleeding throughout his hospital course, and was discharged. DISCUSSION: We present a case of acute lower gastrointestinal bleeding due to multiple colonic polypoid angiodysplasias in a young patient with sickle cell disease, successfully treated with argon plasma coagulation therapy. Colonic angiodysplasia is commonly found in individuals older than 40 years of age, generally appearing as a fern-like flat or elevated bright-red lesion on endoscopy. The polypoid form of angiodysplasia is extremely rare, reported primarily in the sigmoid and transverse colon, and is easily identified based on its striking appearance. Polypoid angiodysplasia has rarely been described in patients less than 50 years of age, and has no known association with sickle cell disease. CT angiography is a potentially crucial non-invasive initial test, as it can possibly detect extravasation from actively hemorrhaging angiodysplasias. Successful endoscopic eradication therapies include argon plasma coagulation, electrocoagulation, and snare polypectomy.

1895 “The First Burn Is the Deepest:” A Cautionary Tale in Superficial APC Therapy for Radiation Proctopathy

INTRODUCTION: Globally, prostate cancer is the most commonly diagnosed cancer in men. Radiation therapy remains a mainstay in the armamentarium in the treatment of this disease. Radiation proctopathy is a common side effect of this treatment modality with an incidence in patients treated with brachytherapy alone estimated to range from 8 to 13%, and up to 21% in combination with other modalities [2]. Radiation proctopathy typically presents with diarrhea, mucoid discharge, urgency, tenesmus, and bleeding. Argon plasma coagulation (APC) has become the primary therapeutic modality in the management of radiation injury. It is essential that physicians of all specialties (as well as others who care for these patients) be aware of the multiple complications of this therapy. More severe adverse events, notably rectal ulcers following APC therapy are not uncommon, with an incidence ranging from 3 to 16%. CASE DESCRIPTION/METHODS: A 67-year-old man with a history of prostate cancer treated with radiation therapy one year prior presented with intermittent rectal bleeding for one and a half months. A colonoscopy was performed, which revealed a small area near the dentate line characterized by slightly oozing neovascularized tissue consistent with radiation proctopathy. This area was treated with APC with good effect. Biopsies of this area revealed hyperplastic crypts, lamina propria fibrosis, and vascular ectasias compatible with radiation injury. Three months following treatment, the patient developed recurrent rectal bleeding. A flexible sigmoidoscopy revealed a deep non-bleeding ulcer in the rectum. Subsequent CT enterography and MRI of the pelvis demonstrated a deep rectal ulcer with abutment of a 1.5cm peri-prostatic abscess. The patient was followed closely over the next several months in concert with colorectal surgical colleagues, with serial imaging and subsequent resolution of the peri-prostatic abscess as well as cessation of rectal bleeding. DISCUSSION: As more patients with prostate cancer are treated with radiation therapy the incidence of radiation proctopathy is increasing. Although argon plasma coagulation has been shown to be an effective therapy for this issue, providers must consider and discuss with patients the potential complications of this otherwise effective and generally well-tolerated mode of treatment.

2133 Hybrid Argon Plasma Coagulation Therapy for Early Esophageal Squamous Cell Carcinoma

INTRODUCTION: Squamous cell carcinoma is common in Asia, accounting for most cases of esophageal cancer throughout the world, whereas adenocarcinoma is more common in the Western world. Overall, neoplasms of the esophagus carry a poor prognosis. Treatment options depend on the stage of the disease. Endoscopic therapy may be considered for early disease as endoscopic resection is a safe and minimally invasive treatment option for Tis and T1a esophageal malignancies. Esophagectomy is necessary for invasive disease. CASE DESCRIPTION/METHODS: A 56 years-old male was found to have non-circumferential mucosal irregularities between 25-27 cm from the incisors (Figure 1). Biopsy of the irregular mucosa revealed atypical squamous proliferation, consistent with squamous cell carcinoma in-situ (Tis). Subsequent endoscopic ultrasound (EUS) evaluation revealed thickened mucosa without the involvement of the deep mucosa or muscularis propria. Endoscopic mucosal resection (EMR) was performed and pathology confirmed clear margins. Subsequent surveillance EGD revealed the persistence of atypical squamous mucosa however extensive post-EMR scarring prevented repeat mucosal resection. The patient refused surgical intervention and the decision was made to pursue hybrid APC ablation of the remaining esophageal mucosa. The esophageal mucosa was lavaged with Lugoll’s Iodine to expose the affected squamous epithelium. The affected areas were then lifted with a solution of saline and methylene blue and ablated using argon plasma coagulation at 50 W (Figure 2). DISCUSSION: APC has been successfully used in similar applications; to ablate tissue margins after endoscopic resection of early neoplasia. The development of hybrid APC and its inherent improved safety profile allows for an extension of its application to include primary treatment of dysplastic and neoplastic lesions. In one recent study, tissue damage was limited to the submucosal layer regardless of application time. This case describes an effective novel use of Hybrid APC for treatment of Tis esophageal squamous cell carcinoma.

Sa1220 EVALUATION OF THE EFFICACY AND SAFETY OF TWO TREATMENTS FOR ESOPHAGEAL CANCER: PHOTODYNAMIC THERAPY AND ENDOSCOPIC ARGON PLASMA COAGULATION. WHICH SHOULD WE SELECT?

In clinical practice to treat esophageal cancer, both photodynamic therapy (PDT) and argon plasma coagulation therapy (APC) are often used because they are less invasive than surgery and chemoradiotherapy. In japan, because PDT requires sophisticated equipment, its availability is limited to few hospitals. On the other hand, APC is more available than PDT. The selection criteria for esophageal cancer therapy has not been definitely established. For better therapeutic selection, we retrospectively investigated the efficacy and safety of PDT and APC in esophageal cancer.

A Rare Case of Bleeding Duodenal Arteriovenous Malformations in Association with Amyloid Enteropathy

Amyloidosis is a rare disease caused by accumulation of abnormal amyloid fibrils within the extracellular matrix leading to structural and functional disruption of the involved tissue. Gastrointestinal (GI) involvement is seen in primary, secondary and dialysis related amyloidosis. AVM's (arteriovenous malformations) in association with amyloidosis are a rare cause of GI bleed. We report an unusual case of duodenal AVM's associated with gastrointestinal amyloidosis (AL), presenting as an acute upper GI bleed. An 82-year old Caucasian male with history of coronary artery disease and atrial fibrillation on anticoagulation, presented with a complaint of melena. Physical examination was significant for pallor. Laboratory investigation revealed iron deficiency anemia with a hemoglobin of 7.9 g/dL. Subsequent EGD showed thickened small bowel polypoidal mucosal folds with multiple AVM's in the second and third portions of the duodenum, few of which were bleeding actively. APC (Argon Plasma Coagulation) therapy of the bleeding AVM's was performed with resultant satisfactory hemostasis. Mucosal biopsies of the thickened duodenal folds were also performed. Histology revealed amyloidosis involving the muscularis mucosa and vessels, which displayed an apple green birefringence under polarized light microscopy using Congo Red stain (Figure 1).2010 Figure 1. (a, arrow) Thickened polypoidal mucosal folds (b, arrow) Multiple AVM's visualized in the duodenum (c, arrow) Actively bleeding AVM (d) Duodenal wall H&E stain showed homogenous eosinophilic deposits of muscularis mucosa and vessels, suggestive of amyloid enteropathy; (e, arrow). Positive Congo red staining of amyloid deposits in the vessel (f) Apple green birefringence (arrow) of Congo red stain under fluorescence polarized microscopy confirmed amyloid rich deposition.Further laboratory investigation revealed a negative urine immunofixation test for monoclonal free and ? light chains. Mass spectroscopy revealed AL type amyloidosis, however the workup for plasma cell dyscrasias (multiple myeloma/Waldenstorm macroglobulinemia) was negative. GI tract involvement occurs more often with AA amyloidosis rather than with the AL type. Patients with amyloid enteropathy can present with GI bleeding, the etiology of which is usually secondary to ischemia, mucosal ulcers, and submucosal hematomas. Rarely AVM's have been found to be associated with amyloidosis. Published data has shown such association as with gastric and pulmonary AVM's. This case demonstrates a rare presentation of GI bleed in the setting of amyloid enteropathy secondary to duodenal AVM's. This is the first reported case of bleeding duodenal AVM's with amyloidosis. Hence it is our recommendation, that the presence of AVM's with thickened or polypoidal small bowel folds should prompt the endoscopist to rule out amyloidosis.

Endoscopic therapy for Barrett's esophagus and early esophageal cancer: Where do we go from here?

Since Barrett’s esophagus is a precancerous condition, efforts have been made for its eradication by various ablative techniques. Initially, laser ablation was attempted in non-dysplastic Barrett’s esophagus and subsequently, endoscopic ablation using photodynamic therapy was used in Barrett’s patients with high-grade dysplasia who were poor surgical candidates. Since then, various ablative therapies have been developed with radiofrequency ablation having the best quality of evidence. Resection of dysplastic areas only without complete removal of entire Barrett’s segment is associated with high risk of developing metachronous neoplasia. Hence, the current standard of management for Barrett’s esophagus includes endoscopic mucosal resection of visible abnormalities followed by ablation to eradicate remaining Barrett’s epithelium. Although endoscopic therapy cannot address regional lymph node metastases, such nodal involvement is present in only 1% to 2% of patients with intramucosal adenocarcinoma in Barrett esophagus and therefore is useful in intramucosal cancers. Post ablation surveillance is recommended as recurrence of intestinal metaplasia and dysplasia have been reported. This review includes a discussion of the technique, efficacy and complication rate of currently available ablation techniques such as radiofrequency ablation, cryotherapy, argon plasma coagulation and photodynamic therapy as well as endoscopic mucosal resection. A brief discussion of the emerging technique, endoscopic submucosal dissection is also included.

322 - Comparison of Pharmacotherapy, Argon Plasma Coagulation and Combination Therapy in the Treatment of Weight Regain after Roux-En-Y Gastric Bypass

322 - Comparison of Pharmacotherapy, Argon Plasma Coagulation and Combination Therapy in the Treatment of Weight Regain after Roux-En-Y Gastric Bypass

Efficacy and Safety of Argon Plasma Coagulation for Hemorrhagic Chronic Radiation Proctopathy: A Systematic Review.

Hemorrhagic chronic radiation proctopathy (CRP) is a common complication after pelvic radiotherapy in patients with prostate or gynecological cancers. This systematic review was conducted to evaluate the efficacy and safety of argon plasma coagulation (APC) in treating hemorrhagic CRP. The databases of PubMed, Embase, and Cochrane Library were searched for related studies from inception to July 2017. Finally, 33 studies were identified with a total of 821 hemorrhagic CRP patients. After APC treatment, hemoglobin levels increased from 7.7–13.4 g/L to 11–14 g/L (including 15 studies). All (n = 33) studies reported an effective rate in rectal bleeding, among which five studies had a rate of 100%. Short-term complications were reported in 31 studies, while long-term complications in 33 studies and no complication in 11 studies. As for the severe complications, perforation was reported by 2 out of 33 studies, and the incidences were 3.3% (1/30) and 3.7% (1/27), respectively. As for APC setting, argon gas flow rate (median 1.5 L/min) and electric power (median 50 W) had no significant influence on complications and hemostasis. In conclusion, current literature indicated that APC therapy was an effective and safe strategy for hemorrhagic CRP, and large-scale prospective studies are needed to warrant our study.

Upper Gastrointestinal Bleeding in Children: A Tertiary United Kingdom Children's Hospital Experience.

The aim of this study was to review the aetiology, presentation and management of these patients with upper gastrointestinal bleeding (UGIB) at a tertiary children’s unit in the United Kingdom. This was a retrospective single-institution study on children (<16 years) who presented with acute UGIB over a period of 5 years using known International Classification of Diseases (ICD) codes. A total of 32 children (17 males, 15 females) were identified with a total median age at presentation of 5.5 years. The majority (24/32) of patients presented as an emergency. A total of 19/32 presented with isolated haematemesis, 8/32 with isolated melaena and 5/32 with a combination of melaena and haematemesis. On admission, the mean haemoglobin of patients who presented with isolated haematemesis was 11 g/dL, those with isolated melaena 9.3 g/dL and those with a combination 7.8 g/dL. Blood transfusion was required in 3/19 with haematemesis and 3/5 with haematemesis and melaena. A total of 19/32 underwent upper gastrointestinal endoscopy. Endoscopic findings were oesophageal varices (5/19) of which 4 required banding; bleeding gastric ulcer (1/19) requiring clips, haemospray and adrenaline; gastric vascular malformation (1/19) treated with Argon plasma coagulation therapy; duodenal ulcer (3/19) which required surgery in two cases; oesophagitis (5/19); and gastritis +/− duodenitis (3/19). A total of 13/32 patients did not undergo endoscopy and the presumed aetiology was a Mallory–Weiss tear (4/13); ingestion of foreign body (2/13); gastritis (3/13); viral illness (1/13); unknown (2/13). While UGIB is uncommon in children, the morbidity associated with it is very significant. Melaena, dropping haemoglobin, and requirement for a blood transfusion appear to be significant markers of an underlying cause of UGIB that requires therapeutic intervention. A multi-disciplinary team comprising gastroenterologists and surgeons is essential.

Evaluation of argon plasma coagulation in healing of a solitary rectal ulcer in comparison with conventional therapy: a randomised controlled trial.

IntroductionArgon plasma coagulation (APC) has been reported to be effective in the treatment of solitary rectal ulcer syndrome (SRUS). However, it has not appeared to be effective in healing ulcers.AimThis study aimed at assessing the effectiveness of APC in controlling rectal ulcer-induced bleeding, and at examining the ultimate effect of this approach in healing these lesions.Material and methodsThis randomised, controlled trial was conducted on 99 patients with SRUS. Patients were randomly enrolled into two groups of APC therapy (intervention) and conventional therapy (control). The control group (n = 58) received a high-fibre diet, laxatives, behaviour therapy, and sucralfate enemas, and the intervention group (n = 41) were treated with APC plus conventional therapy; in fact they received directed and focused argon gas in addition to a high-fibre diet and laxatives.ResultsResponses to treatment in the control group and in the APC-receiving group were 29.3% and 75.6%, respectively. The continuation of ulcer healing after 3 months in the control group was 10.3%, and it was 70.7% in the APC-treated group. There was a significant statistical difference between the two groups (p < 0.004), i.e. bleeding was controlled more frequently in the group receiving APC plus conventional therapies than in the group receiving only the conventional therapies. However, the results showed no statistically significant difference between the two groups in terms of pain relief (p < 0.36).ConclusionsArgon plasma coagulation not only controlled bleeding in patients with SRUS, but also, in comparison with the conventional methods of treating SRUS, led to healing and continuation of healing of rectal ulcers.

食道癌術後に気道狭窄を来した気管腫瘍に対しアルゴンプラズマ凝固(APC)治療と放射線照射により良好な経過を得た1例

食道癌術後に気道狭窄を来した気管腫瘍に対しアルゴンプラズマ凝固(APC)治療と放射線照射により良好な経過を得た1例

Argon plasma coagulation therapy after submucosal injection ofnormal saline solution for local recurrence of large nonampullary duodenal neoplasm.

Argon plasma coagulation therapy after submucosal injection ofnormal saline solution for local recurrence of large nonampullary duodenal neoplasm.

Argon plasma coagulation for the endoscopic treatment of gastrointestinal tumor bleeding: A retrospective comparison with a non-treated historical cohort.

The endoscopic use of argon plasma coagulation (APC) to achieve hemostasis for upper gastrointestinal tumor bleeding (UGITB) has not been adequately evaluated in controlled trials. This study aimed to evaluate the efficacy of APC for the treatment of upper gastrointestinal bleeding from malignant lesions. Between January and September 2011, all patients with UGITB underwent high-potency APC therapy (up to 70 Watts). This group was compared with a historical cohort of patients admitted between January and December 2010, when the endoscopic treatment of bleeding malignancies was not routinely performed. Patients were stratified into two categories, grouping the Eastern Cooperative Oncology Group (ECOG) performance status scale: Category I (ECOG 0-2) patients with a good clinical status and Category II (ECOG 3-4) patients with a poor clinical status. Our study had 25 patients with UGITB whom underwent APC treatment and 28 patients whom received no endoscopic therapy. The clinical characteristics of the groups were similar, except for endoscopic active bleeding, which was more frequently detected in APC group. We had 15 patients in the APC group whom had active bleeding, and initial hemostasis was obtained in 11 of them (73.3%). In the control group, four patients had active bleeding. There were no differences in 30-day re-bleeding (33.3% in the APC group versus 14.3% in the control group; p = 0.104) and 30-day mortality rates (20.8% in the APC group, versus 42.9% in the control group; p = 0.091). When patients were categorized according to their ECOG status, we found that APC therapy had no impact in re-bleeding and mortality rates (Group I: APC versus no endoscopic treatment: re-bleeding p = 0.412, mortality p = 0.669; Group II: APC versus no endoscopic treatment: re-bleeding p = 0.505, mortality p = 0.580). Hematemesis and site of bleeding located at the esophagus or duodenum were associated with a higher 30-day mortality. Endoscopic hemostasis of UGITB with APC has no significant impact on 30-day re-bleeding and mortality rates, irrespective of patient performance status.

Gastric Antral Vascular Ectasia: Can Radiofrequency Ablation Be the Answer?

Background: Gastric antral vascular ectasia (GAVE) was first reported in 1953. The pathophysiology remains unknown. Conditions characteristically associated with GAVE are cirrhosis, autoimmune disorders e.g. scleroderma, chronic kidney disease, bone marrow transplantation. Surgical treatment options like gastric antrectomy have significant associated morbidity and mortality (Jensen et al, 2004). And while Argon plasma coagulation (APC) is an effective treatment, it requires frequent sessions and is rarely curative. (Tuveri et al, 2007). Case Report: A 62 year old white male was referred to our GI clinic for chronic iron deficiency anemia. His medical history included CAD s/p PCI, Cryptogenic cirrhosis s/p TIPS and he presented with multiple GI bleeds in the past. He underwent several endoscopies revealing portal hypertensive gastropathy, grade II esophageal varices and bleeding GAVE lesions. APC was performed twice at outside facilities for GAVE and symptomatic anemia. On evaluation, patient denied overt bleeding. Examination revealed anicteric sclera with pale conjunctivae. Abdomen was soft and distended with hepatosplenomegaly and 1+ pitting leg edema. Laboratory data revealed iron deficiency with Hb 10gm/dl. Despite undergoing 8 APC sessions at our facility, he remained iron deficient and symptomatic from anemia, requiring repeated transfusions. As he was refractory to APC therapy, decision was made to proceed with Radio Frequency Ablation (RFA) with Halo 90. A total of 5 sessions over 1 year led to resolution of anemia and transfusion requirements (Details in Table 1). Discussion: GAVE is an uncommon etiology of upper GI bleeding. These patients usually present with iron deficiency anemia. Medical, surgical and endoscopic therapies have been proposed with varying results and APC is considered a good first line treatment (Sebastian et al, 2004). Data regarding the utility of RFA for GAVE is limited to a handful of cases refractory to APC (Gross et al, 2007). Our patient showed significant improvement in symptoms, anemia and transfusion needs. Prior to RFA, he required 80 units of blood transfusions over 2 years. Post RFA session 1, he required 2 units and has since been transfusion free for the last 2 years, with a significantly improved quality of life. Whether the improvement in anemia has a linear relationship with the number of RFA sessions remains unknown. Challenges remain in treating GAVE patients due to the rarity of this condition and the lack of available literature. We propose that RFA be considered a treatment option for patients who fail APC therapy.Table 44