Argon Plasma Coagulation Therapy Research Articles

慢性腎不全に合併したgastric antral Vascular ectasia (GAVE)の1症例

A 76-year-old woman was admitted to our hospital complaining of tarry stool, general fatigue and marked anemia(Hb 5.2 g/dl). Gastric endoscopic findings showed longitudinal red stripes and diffuse erythematous spots, indicating dilated vascular vessels. They resembled the stripes of a watermelon at the gastric antrum. The marked anemia was caused by chronic blood loss from the abnormally dilated mucosal and submucosal capillary veins in the gastric antrum. She was diagnosed as having gastric antral vascular ectasia(GAVE) with chronic renal failure(CRF). The association of GAVE and CRF is considered to be rare according to previous reports in Japan. Endoscopic argon plasma coagulation therapy was performed three times. After therapy, capillary dilatation disappeared, and the marked anemia was greatly improved. Argon plasma coagulation therapy was found to be a safe and effective procedure for this disease. Although GAVE is essentially a benign gastric disease, endoscopic therapy should be the treatment of first choice for this disease.

Outcomes of Treatment of Argon Plasma Coagulation Therapy in Elderly or High-risk Patients With Early Gastric Cancer

In the treatment of gastric cancer, argon plasma coagulation (APC) has certain merits, such as short operation time, easy procedure, and lack of serious complications compared with endoscopic mucosal resection or endoscopic submucosal dissection, suggesting that this modality may be appropriate for some patients with gastric cancer. The aim of this study was to assess the therapeutic outcomes of APC in aged and/or high-risk patients with early gastric neoplasm. Fifty gastric neoplastic lesions (25 early gastric cancers and 25 adenomas) in patients with severe complications were treated with APC and followed up for a mean of 3.6 years (range: 0.5 to 6.6 y). The long-term outcomes of APC therapy and its efficacy as a first-line treatment were compared in patients with those lesions treated by experienced and nonexperienced endoscopists. Recurrence after APC therapy occurred in 5 lesions (10.0%), with an annual relapse rate of 1.8%. The mean time to recurrence was 1.5 years. The total procedure time of APC treatment was 14.5±2.6 minutes for experienced endoscopists and 16.4±2.2 minutes for nonexperienced endoscopists, with a significant time difference between the 2 groups (P<0.05). However, the outcomes did not differ by endoscopic experience. There were no serious complications, such as perforation, bleeding, or infection. APC therapy seems to be a safe and useful treatment for patients with early gastric neoplasm and a high risk of severe complications. Equal therapeutic outcomes were obtained by experienced and nonexperienced endoscopists.

Endoscopic treatment of antral vascular ectasia – nationwide multicenter survey. APC or ligation?

Introduction: Antral vascular ectasia is type of gastic vascular malformations, which can lead even to chronic iron-definciency anaemia or severe acute blood loss. About 30% of it can be observed in patients with liver cirrhosis, but there are a lot of other associated diseases (mainly autoimmune diseases) as well. The classic „watermelon“ type forms red streaking of the antrum with convergence at the pylorus with visible small, tortous vessels, but the diffuse form is similar to the antral gastritis. The severity of the disease is not associated with portal hypertension even in patients with cirrhosis. Effective medical treatment does not exist, therefore various endoscopic treatment modalities can be used. Aim: We sent a questionnary to major hungarian endoscopic centers to get information about endoscopic treatment of this rare entity. Patients & methods: We got data of 37 evaluable patients from 7 centers. 56% of them were women, the mean age was 67.2 (32–85) years. Liver cirrhosis was the underlying disease in 21 (56.8%) patients. Watermelon type was observed in 60% of all cases, while the occurence of diffuse form varied markedly between centers (0–70%). 30 patients were treated exclusively by argon plasma coagulation (APC), 6 patients were treated by ligation therapy (1 after unsuccessful APC therapies) and one patient had to be operated on in acute settings. Patients in APC group were treated at median 3 (1–20) sessions, the median number of ligation therapy was 1.5 (1–4). Results: In APC group two patients died, both due to hepatic coma, in 1 patient acute TIPS insertion had to be performed due to uncontrollable bleeding, but in the majority of remaining patients the intensity of blood loss, the need for further blood transfusion and hospitalisation decreased in followed ones. In 6 patients treated by ligation therapy 5 cases were evidently successfull with no further blood transfusion and hospitalisation in the follow up period of 3–24 months. Conclusion: The endoscopic treatment of antral vascular ectasia can be successfull for long term in majority of cases using APC or ligation therapy. Ligation therapy seems to be superior and more cost effective, but it needs further confirmation in larger group of patients.

Randomised Trial of Argon Plasma Coagulation (APC) Therapy Verses Topical Formalin for Persistent Rectal Bleeding and Anorectal Dysfunction After Radiation Therapy (RT) for Carcinoma of the Prostate (CAP)

G A A b st ra ct s Correlation between confidence ratings and diarrhea actually occurring at next BM was moderately strong for warnings (Spearman rho=0.49, p<0.0001) but modest for triggers (rho=0.25, p<0.0001). Only confidence ratings of 70%+ for warnings and 90%+ for triggers were associated with better than even chance of diarrhea at next BM. Average time lag until BM was longer for triggers vs. warnings: 15+ min for 81.6% vs. 57.7% of instances, and 30+ min for 68.7% vs. 42.8% of instances. CONCLUSIONS: Diarrhea is preceded by recognizable warning sensations and trigger events at least some of the time for most people with recurrent diarrhea, but warnings are more useful as they occur more frequently and are more likely to be followed by actual diarrhea. Higher confidence in diarrhea occurring after these antecedent experiences is associated with greater accuracy of diarrhea prediction. [Supported by a grant from McNeil Consumer Healthcare]

Argon plasma coagulation is an effective treatment in cirrhosis- related gastric antral vascular ectasias

IntroductionGastric antral vascular ectasias (GAVE) represent an uncommon cause of upper GI bleeding (UGIB). There is an association with liver cirrhosis and portal hypertension in 30% of the patients, and...

Diagnosis of gastric antral vascular ectasia by transnasal flexible spectral imaging color enhancement.

The endoscopic appearance of gastric antral vascular ectasia (GAVE) can be easily misinterpreted as inflammatory changes of gastric mucosa. We report on a case of GAVE that had been missed by conventional transnasal endoscopy but was diagnosed by flexible spectral imaging color enhancement (FICE) with a transnasal endoscope. A 45-year-old woman with severe anemia presented with a 1-month history of increasing fatigue. She was previously diagnosed as having acute antral gastritis by conventional transnasal endoscopy (EG 530N2) because of the presence of reddish mucosal changes on the entire antral rugal fold. However, the FICE images produced using a combination of new processor system (VP4450) and new small-caliber endoscope (EG 530NW), did not show reddish mucosal changes on the entire rugal fold, but gave a clear image of dilated vessels associated with GAVE distinct from the surrounding normal mucosa on the same fold. These findings are useful to differentiate GAVE from ordinary gastritis. The lesions of GAVE were managed with a combination of focal pulse and spray-painting techniques to obliterate the bulk of the disease in two sessions of argon plasma coagulation therapy. Three months later, the patient recovered from iron deficiency anemia with an oral medication of iron tablets.

Reply to Rodrigues et al.

We sincerely thank Rodrigues et al. for their comments on our article regarding the long-lasting effect of argon plasma coagulation (APC) therapy in patients with chronic radiation proctitis [1]. Indeed, rectal bleeding due to radiation proctitis represents a challenging condition for physicians, as its management is still under consideration.

Videoendolaringeal'naya khirurgiya i fotodinamicheskaya terapiya s ispol'zovaniem gibkoy endoskopicheskoy tekhniki pri predrake i rannem rake gortani

The authors have developed and used a number of endolaryngeal surgical procedures for the treatment of patients with laryngeal precancer and cancer (LC), by using flexible video-assisted endoscopic technology, Nd:YAG laser thermoablation, argon plasma coagulation, electric resection, and photodynamic therapy. In 1987 to 2008, endolaryngeal surgery was performed in 129 patients, including 23 with dyskeratosis with laryngeal dysplasia, 36 with virus-associated recurrent laryngeal papillomatosis, 37 with early cancer of the midlarynx (Tis - T1N0M0), 17 with residual tumor, and 16 with local recurrent cancer of the midlarynx (T1-2N0M0) after teleradiotherapy. The therapy resulted in complete regression (CR) of dyskeratosis and first-to-third degree dysplasia in 22 (95%) of the 23 patients. CR was achieved in 27 (75%) of the 36 patients in the recurrent laryngeal papillomatosis group. Persistent remission and human papillomavirus eradication were brought about in 70% of cases. CR was obtained in 34 (92%) of the 37 patients in the primary LC group. Recurrent LC was found in 3 (9%) of the 34 patients. Complete recovery of vocal cord function recovery was noted in all cases. CR could be achieved in 27 (82%) in the residual and recurrent laryngeal tumor groups (n = 33). Recurrent LC was detected in 3 patients 1-5 years after treatment completion.

W1429: Effectiveness, Safety and Quality of Life of Argon Plasma Coagulation vs. Hyperbaric Oxygen Therapy in Chronic Radiation Proctopathy

Chronic radiation proctopathy (CRP) manifests as persistent and/or recurrent rectal bleeding and can be associated with anemia, transfusional requirements and hospitalization which translate into a diminished quality of life (QOL). Argon Plasma Coagulation (APC) and Hyperbaric Oxygen Therapy (HOT) have both been shown to be effective in the control of CRP. No prospective comparison has been reported between these treatments.

Treatment for Barrett's oesophagus.

Treatments for Barrett's oesophagus, the precursor lesion of adenocarcinoma, are available but whether these therapies effectively prevent the development of adenocarcinoma, and in some cases eradicate the Barrett's oesophagus segment, remains unclear. To summarise, quantify and compare the efficacy of pharmacological, surgical and endoscopic treatments for the eradication of dysplastic and non-dysplastic Barrett's oesophagus and prevention of these states from progression to adenocarcinoma. We searched CENTRAL (The Cochrane Library 2004, issue 4), MEDLINE (1966 to June 2008) and EMBASE (1980 to June 2008). Randomised controlled trials (RCTs) comparing medical, endoscopic or non-resectional surgical treatments for Barrett's oesophagus. The primary outcome measures were complete eradication of Barrett's and dysplasia at 12 months, and reduction in the number of patients progressing to cancer at five years or latest time point. Three authors independently extracted data and assessed the quality of the trials included in the analysis. Sixteen studies, including 1074 patients, were included. The mean number of participants in the studies was small (n = 49; range 8 to 208). Most studies did not report on the primary outcomes. Medical and surgical interventions to reduce symptoms and sequelae of gastro-oesophageal reflux disease (GORD) did not induce significant eradication of Barrett's oesophagus or dysplasia. Endoscopic therapies (photodynamic therapy (PDT with aminolevulinic acid or porfimer sodium), argon plasma coagulation (APC) and radiofrequency ablation (RFA)) all induced regression of Barrett's oesophagus and dysplasia. The data for photodynamic therapy were heterogeneous with a mean eradication rate of 51% for Barrett's oesophagus and between 56% and 100% for dysplasia, depending on the treatment regimens. The variation in photodynamic therapy eradication rates for dysplasia was dependent on the drug, source and dose of light. Radiofrequency ablation resulted in eradication rates of 82% and 94% for Barrett's oesophagus and dysplasia respectively, compared to a sham treatment. Endoscopic treatments were generally well tolerated, however all were associated with some buried glands, particularly following argon plasma coagulation and photodynamic therapy, as well as photosensitivity and strictures induced by porfimer sodium based photodynamic therapy in particular. Despite their failure to eradicate Barrett's oesophagus, the role of medical and surgical interventions to reduce the troubling symptoms and sequelae of GORD is not questioned. Whether therapies for GORD reduce the cancer risk is not yet known. Ablative therapies have an increasing role in the management of dysplasia within Barrett's and current data would favour the use of radiofrequency ablation compared with photodynamic therapy. Radiofrequency ablation has been shown to yield significantly fewer complications than photodynamic therapy and is very efficacious at eradicating both dysplasia and Barrett's itself. However, long-term follow-up data are still needed before radiofrequency ablation can be used in routine clinical care without the need for very careful post-treatment surveillance. More clinical trial data and in particular randomised controlled trials are required to assess whether or not the cancer risk is reduced in routine clinical practice.

Risk factors for recurrence of acute gastrointestinal bleeding from angiodysplasia

Recurrent bleeding from gastrointestinal (GI) angiodysplasia remains a therapeutic challenge. Identification of factors predicting poor outcome of haemorrhage from angiodysplasia would help us to select the patients who may likely benefit from further therapy. Thus, we analysed risk factors for recurrence of acute GI haemorrhage from angiodysplasia. 62 patients admitted consecutively with acute GI bleeding from angiodysplasia, between June 2002 and June 2006, were included. Bivariate, multivariate and survival analysis were performed to identify risk factors for recurrence of bleeding after hospital discharge. Recurrence of acute haemorrhage after hospital discharge occurred in 17 of 57 (30%) patients (38 men; mean age: 74+/-6 years), after a mean follow-up (33+/-40 months). On Cox analysis, earlier history of bleeding with a high bleeding rate, over anticoagulation and the presence of multiple lesions were predictive factors of recurrence in a multivariate analysis. In contrast, endoscopic argon plasma coagulation (APC) therapy was not associated with lower rates of recurrent bleeding. In patients with acute GI haemorrhage from angiodysplasia, earlier bleeding with a high bleeding rate, over anticoagulation and multiple angiodisplasic lesions predict an increased risk of recurrent bleeding. Although there is a trend towards better management with endoscopic APC therapy for the prevention of recurrence of bleeding, endoscopic APC therapy is not predictive of a lower rate of recurrence.

Comparison of Hemostatic Efficacy for Argon Plasma Coagulation and Distilled Water Injection in Treating High-risk Bleeding Ulcers

Endoscopic treatment is recommended for initial hemostasis in nonvariceal upper gastrointestinal bleeding. Many endoscopic devices have been demonstrated to be effective in the hemostasis of bleeding ulcers. However, the hemostatic efficacy of argon plasma coagulation (APC) has not been widely investigated. From February 2007 to February 2008, 271 consecutive patients with high-risk bleeding ulcers, characterized by active bleeding, nonbleeding visible vessels and adherent clots, were admitted to our hospital. Among these patients, 135 nonrandomly underwent either APC therapy or distilled water injection. Pantoprazole infusion was conducted during the fasting period after endoscopy and orally for 8 weeks to encourage ulcer healing. Episodes of rebleeding were retreated with endoscopic combination therapy. Patients who did not benefit from retreatment underwent emergency surgery. In all,135 patients were enrolled, among whom 6 with gastric malignancy, acute severe illness or multiple bleeding sites were excluded. Finally, hemostatic efficacy in 59 patients treated with APC was prospectively compared with 70 patients treated with distilled water injection. The two treatment groups were similar with respect to all baseline characteristics. Initial hemostasis was accomplished in 57 patients treated with APC, and 64 patients with distilled water injection therapy (97% vs. 91%, P=0.29). Bleeding recurred in 6 patients treated with APC, and in 17 patients treated with distilled water injection (11% vs. 27%, P=0.03). No significant differences were observed between the 2 groups in hospital stay, transfusion requirements, surgery and mortality. Endoscopic therapy with APC is more effective than distilled water injection for preventing rebleeding in the treatment of high-risk bleeding ulcers.

WITHDRAWN: Argon plasma coagulation therapy for acute non-variceal upper gastrointestinal bleeding.

Endoscopic treatment is recommended for initial hemostasis in non-variceal upper gastrointestinal bleeding. Many endoscopic hemostatic devices are used. Argon Plasma Coagulation (APC) is an alternative. This study reviews all available literature to access the efficacy of APC compared to other endoscopic therapies in the control of acute non-variceal upper GI hemorrhage. We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4 2003), MEDLINE 1966 to December 2003, EMBASE 1980 to December 2003, Web of Science for SCISEARCH (1980 to December 2003), BIOSIS (1985 to December 2003), and the National Research Register Issue 4 2003. We also handsearched abstracts from conference proceedings of the United European Gastroenterology Week and Digestive Disease Week. Randomized, controlled trials of APC compared with other endoscopic hemostasis interventions in the treatment of non-variceal upper gastrointestinal bleeding. Two reviewers assessed trial quality and independently extracted data. Two trials involving 121 people were included. There was no common intervention to pool. One trial compared APC to heat probe, another trial compared APC to injection sclerotherapy. There was no significant difference between groups in either of these trials. On the basis of the two randomised controlled trials identified in this review, there is no evidence to suggest that APC is superior to other endoscopic therapies. Further randomised controlled trials are needed.

Gastrointestinal Hemorrhage with Splenic Injury

Purpose: A 55-year-old man with history of polycystic kidney disease status post renal transplant 1 year ago presented to emergency room with symptomatic anemia and melena for 3 weeks with finding of acute drop in hemoglobin to 6 g/dL. The patient takes aspirin, clopidogrel, and immunosuppressants, including oral corticosteroids. He had endoscopic evaluations 5 weeks prior for chronic anemia, which revealed mild esophagitis, small non-bleeding antral ulcer, diverticulosis, non-bleeding internal hemorrhoids, and small arteriovenous malformations of the ascending colon that were treated with argon plasma coagulation therapy. Physical examination revealed a well-appearing man with stable hemodynamics, benign abdomen with normactive bowel sounds, and melenotic stool in rectum. His laboratory values showed hemoglobin of 6.4 g/dL, INR of 1.2, platelet count of 179/mm3, and ferritin level of 11. His EGD revealed a 5 cm serpiginous vascular-appearing anomaly in the midbody of the stomach with red spots suggestive of recent hemorrhage. This vascular anomaly was noted to bleed spontaneously. There were no visible vessels or mucosal defects. Hemastasis was achieved with epinephrine injection. MRA examination showed venous varix in the posterior gastric wall with vascular supply from splenic vessels. Splenic dysmorphism was noted to be an interval development, with normal spleen seen 5 years ago. The patient later admitted to a fall off the roof of his house resulting in trauma to left thorax and broken left foot three years prior. Splenosis is an acquired condition defined as autotransplantation of viable splenic tissue after traumatic or iatrogenic rupture of the spleen during surgery. It is usually found incidentally in asymptomatic patients and commonly found within the abdominal and pelvic cavities. Splenic tissue show distorted architecture without hilum and poorly formed capsule with blood supply from surrounding vessels. The average time interval between trauma and splenosis formation is 10 years. Splenosis can mimic as malignancies radiographically. Gastrointestinal splenosis has been associated with abdominal pain, mass causing bowel obstruction, and rarely as cause of gastrointestinal or intraperitoneal hemorrhage. Definitive diagnosis of splenosis is made through heat damaged erythrocyte scintigraphy and surgical biopsy. In this case, the etiology of gastrointestinal hemorrhage likely resulted from penetration of splenic implants into the gastric mucosa. Massive hemorrhage from splenosis is rare in reported literature, yet it must be included in the differential diagnosis of patients with gastrointestinal hemorrhage and history of splenectomy or splenic injury.

Bleeding inflammatory polyp formation as a complication of argon plasma coagulation therapy on a flat gastric angiodysplasia

Bleeding inflammatory polyp formation as a complication of argon plasma coagulation therapy on a flat gastric angiodysplasia

A Cost-Utility Analysis of Ablative Therapy for Barrett's Esophagus

Recommendations for patients with Barrett's esophagus (BE) include endoscopic surveillance with esophagectomy for early-stage cancer, although new technologies to ablate dysplasia and metaplasia are available. This study compares the cost utility of ablation with that of endoscopic surveillance strategies. A decision analysis model was created to examine a population of patients with BE (mean age 50), with separate analyses for patients with no dysplasia, low-grade dysplasia (LGD), or high-grade dysplasia (HGD). Strategies compared were no endoscopic surveillance; endoscopic surveillance with ablation for incident dysplasia; immediate ablation followed by endoscopic surveillance in all patients or limited to patients in whom metaplasia persisted; and esophagectomy. Ablation modalities modeled included radiofrequency, argon plasma coagulation, multipolar electrocoagulation, and photodynamic therapy. Endoscopic ablation for patients with HGD could increase life expectancy by 3 quality-adjusted years at an incremental cost of <$6,000 compared with no intervention. Patients with LGD or no dysplasia can also be optimally managed with ablation, but continued surveillance after eradication of metaplasia is expensive. If ablation permanently eradicates >or=28% of LGD or 40% of nondysplastic metaplasia, ablation would be preferred to surveillance. Endoscopic ablation could be the preferred strategy for managing patients with BE with HGD. Ablation might also be preferred in subjects with LGD or no dysplasia, but the cost effectiveness depends on the long-term effectiveness of ablation and whether surveillance endoscopy can be discontinued after successful ablation. As further postablation data become available, the optimal management strategy will be clarified.

Endoscopic Hemoclipping Therapy for Gastric Angiodysplasia in a Child

Gastric angiodysplasia is a very rare cause of upper gastrointestinal bleeding in children and adolescents and is considered to be a vascular abnormality with a developmental cause. Gastric angiodysplasia can be managed with various endoscopic methods, including argon plasma coagulation, electrocoagulation, heater probe, sclerotherapy, band ligation, and hemoclipping therapy. We describe a case of gastric angiodysplasia in a 12-year-old boy with hematemesis and melena. Gastroduodenoscopy showed a typical lesion of angiodysplasia with oozing on the posterior wall of the gastric body. We successfully performed endoscopic hemoclipping therapy to heal the bleeding lesion, and no recurrence of bleeding was observed on follow-up. Gastric angiodysplasia should be included in the differential diagnosis of upper gastrointestinal bleeding in children.

Argon plasma coagulation therapy

To give a summary of recent advances in argon plasma coagulation (APC) therapy in gastroenterology. APC has gained importance in gastrointestinal endoscopy during the last decade, and APC technology has improved over time. Recently published studies, mainly consisting of case series, have shown that APC can be used effectively in various forms of gastrointestinal disorders. The complication rates observed during clinical application are low. APC can be considered as a well tolerated and effective treatment approach in endoscopy. Further clinical trials including a comparison of APC to other treatment modalities as well as long-term follow-up after APC treatment are required to clarify the relative value of APC in gastroenterology.

Endoscopic cryotherapy for the management of gastric antral vascular ectasia

Gastric antral vascular ectasia (GAVE) is an uncommon but clinically significant cause of chronic GI bleeding. To assess the efficacy and safety of cryotherapy for endoscopic treatment of GAVE. Patients received 3 sessions of endoscopic cryotherapy at 3-week to 6-week intervals and had a follow-up endoscopy 4 weeks thereafter. They were followed prospectively in terms of clinical and endoscopic response. Tertiary-care center, between October 2004 and April 2006. The patients were 43 to 89 years of age, with a diagnosis of GAVE and documented iron deficiency anemia. Eight patients had a history of overt GI bleeding. Eight patients (67%) had previously been treated with argon plasma coagulation (APC) (median 6 sessions, range 1-10 sessions) and failed to respond or had a recurrence. Twelve patients were enrolled. Six patients (50%) had a complete response, and 6 patients had a partial response. The mean number of units of blood transfused in the period of 3 months before cryotherapy and during the period of follow-up of 3 months was 4.6 and 1.7 units, respectively. An increased mean Hb level, from 9.9 to 11.3 g/dL, was noted. The average duration of the cryotherapy was 5 minutes (range 1-15 minutes). In 32 of 36 cryotherapy treatment sessions performed (89%), it was technically possible to treat more than 90% of GAVE lesions. There were no immediate cryotherapy-related complications, and none of the patients required admission after the procedure. A pilot study from a single center. Endoscopic cryotherapy is a safe and effective treatment for GAVE. It appears to be effective, even for GAVE refractory to APC therapy. Optimal cryogen, delivery device, and treatment protocols are yet to be determined.

Argon Plasma Coagulation Therapy for Early Gastric Cancer Is Effective and Operator Independent

Backgrounds and Aims: Endoscopic mucosal resection (EMR) and/or endoscopic submucosal dissection (ESD) is one of important modalities for early gastric cancers. However, it requires high-leveled techniques and therefore is operator-dependent. On the other hand, argon plasma coagulation (APC) is considered as secondary treatment, such as for recurrence or post-endoscopic treatment, due to difficulties in evaluation of the cure. Accordingly, few reports are available that studies usefulness of APC therapy as a first-line treatment of early gastric cancer. However, APC has merits such as short-operation time, easy procedure, lack of serious complications and operator independent procedures, suggesting that this modality may be positively applied for some patients with early gastric cancers especially in the aged and/or those with complications. In this study, we investigated long-term outcome of early gastric cancers treated with APC and its efficacy as a first-line treatment. Methods: From 2003 to 2007, we performed APC to 50 lesions of gastric neoplasm (25 early gastric cancers and 25 gastric adenomas) in 38 patients (26 male, 12 female, mean 78 ± 8 years) in our hospital and a related hospital, in whom there was no indication of endoscopic therapy due to high risk of severe complications (such as cerebral infarction, paralysis, other malignant disease etc). We investigated the outcomes of such treatment (recurrence) by searching patients' records. In the APC procedure, the argon gas flow of 2 L/min at a power setting of 60-70W was used. In addition, to investigate how the operator skill affects the outcome, we studied the recurrence of the tumors in three patients' cohorts, which were defined according to the experience of the operator (0-3 years, 7-10 years, ≧15 years). Results: A total of 50 lesions were treated with a single APC procedure and followed up for 17-1897 days (median 663 days). Recurrence occurred in 5 lesions (10.0 %, 5/50), with an annual relapse rate of 5.06 %, and mean duration of recurrence was 554 days. Nevertheless re-treatment with APC (three cessions were maximally performed) was successful in all the relapsed lesions. There were no serious complications such as perforation, bleeding, or infection throughout all procedures. In addition, the outcomes were not different according to the experience of the operators. Conclusions: Annual relapse rate of gastric tumors was 5.1% when APC was applied as a first-line treatment. Combining with easy, safe and operator-independent features, this modality could be one of the therapeutic options for early gastric cancers in some patients especially with aged and/or those with complications.