Argon Plasma Coagulation Research Articles

A case report of gastric antral vascular ectasia treated by endoscopic band ligation combined with lauromacrogol injection.

Gastric antral vascular ectasia (GAVE) is a rare acquired lesion characterized by vascular dilation in the gastric antrum, frequently results in occult or overt gastrointestinal bleeding. Endoscopic intervention remains the cornerstone of therapy. Argon plasma coagulation was previously considered a first treatment option. But recently, endoscopic band ligation (EBL) has emerged as an alternative, increasingly favored for its safety and efficacy. Nonetheless, a consensus on the most effective treatment approach has yet to be established. A 74-year-old female was hospitalized for persistent chest tightness and dyspnea for 1 year. Physical examination showed an anemic appearance with normal blood pressure. Upon admission to the hospital, the blood routine examination revealed severe anemia and the fecal occult blood test was persistently positive. The endoscopic observations and histological evidence led to a diagnosis of GAVE for the patient. Considering the poor response to prior pharmacotherapy, endoscopic intervention was selected for this hospitalization. The initial EBL alone did not yield particularly satisfactory results. Combining EBL with lauromacrogol injection as a subsequent treatment resulted in encouraging outcomes. At the 6-week follow-up, the patient exhibited a negative fecal occult blood test, normalization of hemoglobin level, and endoscopic images demonstrated near complete resolution of vascular ectasias. The combination of EBL with lauromacrogol injection has shown a satisfactory short-term outcome, providing a new option for the endoscopic management of GAVE. However, its long-term efficacy still requires further observation.

Soft Coagulation Versus Argon Plasma Coagulation After Large Non-pedunculated Colorectal Polyp Resection: A Meta-analysis.

Thermal ablative methods (such as argon plasma coagulation (APC) and soft tip snare coagulation (STSC) are commonly used to treat polyp margins. We aim to appraise the current literature and compare clinical outcomes between patients with treated (with APC vs. STSC) and non-treated endoscopic mucosal resection (EMR) margins. We searched major databases from inception until November 2023 for randomly controlled trials (RCTs) comparing EMR of large non-pedunculated colorectal polyps with and without treated margins. Pooled data were analyzed for the primary outcome of recurrence at first screening colonoscopy, and adverse events. Analysis was performed using a random effects model and data were reported using 95% CIs. A total of 5 RCT's were found, which included 1020 polyps (577 in treatment and 443 in control groups). Three studies included treatment with STSC and 3 studies used APC as the modality for margin ablation. Of the included patients, 53% were female and the average age was similar between treatment and control groups (65.9 vs. 66.1y). Seventy-one percent of lesions were proximal to the splenic flexure. The mean follow-up to the first colonoscopy and average polyp size were comparable (6.3 vs. 6.2mo; 28.2 vs. 28.0mm, respectively). Pooled analysis showed that margin ablation was associated with significantly lower rates of recurrence [odds ratio (OR) 0.267, 95% CI 0.18-0.4, P<0.001] with low heterogeneity between studies (I2=0%, P=0.47). Pooled analysis showed no significant difference between STSC and APC in terms of recurrence (OR 0.6, 95% CI 0.27-1.7, I2=0%, P=0.3) or adverse events (OR 0.67, 95% CI 0.3-1.6, I2 13%, P=0.46). Our study shows that ablation of EMR margins is very effective at preventing recurrence at first surveillance colonoscopy. We found no difference between STSC or APC in terms of polyp recurrence or adverse outcomes.

Rescue of a biliary extraction basket impaction using argon plasma coagulation

Rescue of a biliary extraction basket impaction using argon plasma coagulation

Heparin-free veno-venous ECMO for airway obstruction: A case report and review of literature

Rationale: Life-threatening airway obstructions caused by tumors demand prompt and effective intervention. Traditional surgical methods are often complicated by bleeding risks, especially with the use of anticoagulation during extracorporeal membrane oxygenation (ECMO). This report investigates the innovative application of heparin-free veno-venous ECMO (VV-ECMO) to minimize bleeding risks while maintaining effective oxygenation during airway obstruction surgeries, thereby offering a safer alternative in high-risk scenarios. Patient concerns: A 44-year-old female with a history of recurrent synovial sarcoma presented with severe dyspnea, requiring a forced lateral position to breathe. A chest CT scan revealed a complete obstruction of the left mainstem bronchus by a tumor. Diagnoses: The patient was diagnosed with airway obstruction secondary to metastatic synovial sarcoma. Interventions: Preemptive heparin-free VV-ECMO was initiated before general anesthesia to maintain oxygenation. Surgical resection of the obstructing tumor was performed using rigid bronchoscopy and high-frequency electrocautery, followed by argon plasma coagulation to control bleeding. Outcomes: Postoperatively, the patient showed significant improvement in respiratory status. VV-ECMO was successfully weaned off, and the patient was extubated shortly after surgery. She was discharged in stable condition 4 days later. Lessons: Heparin-free VV-ECMO is an effective strategy for managing airway obstructions in patients at high-risk of bleeding. This case supports the use of ECMO without anticoagulation in airway surgeries, offering a balance between maintaining oxygenation and reducing bleeding complications.

Treatment of a staple-line leak after laparoscopic sleeve gastrectomy using an esophagoduodenal Niti-S Mega-stent.

A 56-year-old female with class 3 obesity, was previously submitted to laparoscopic sleeve gastrectomy (LSG) two weeks before current admission. The patient was admitted due to fever, abdominal pain and vomiting. CT revealed a 13.5cm collection between the gastric wall and left hepatic lobe. Piperacillin-Tazobactam was initiated, and percutaneous drainage of the purulent collection was performed. The upper endoscopy showed pus in the gastric lumen and a 10-mm leak at the esophago-gastric junction with contrast extravasation. Argon plasma coagulation (40W, 2L/min) was applied at the orifice margins to promote healing. After 0,038'' guidewire placement through the proximal jejunum, a Niti-S™-MEGA™ (Mega-Stent) 28x230mm (Taewoong Medical™) was deployed under fluoroscopic control. CT at 72h showed absence of leakage. Oral nutrition was started uneventfully. Ambulatory endoscopy was scheduled for eight weeks later to remove the stent, which was easily accomplished with a foreign body forceps. Granulation tissue was observed in the previous leak location and no extraluminal contrast was observed at fluoroscopic evaluation, confirming complete healing and successful endoscopic treatment. Three weeks after stent removal, the patient presented with dysphagia. Upper endoscopy revealed a short and narrowed lumen stenosis at 28cm from the incisives, which was easily manage through TTS balloon dilation. No additional complications were observed.

Comparative clinical feasibility of antireflux mucosectomy and antireflux mucosal ablation in the management of gastroesophageal reflux disease: Retrospective cohort study.

No definitive treatment has been established for refractory gastroesophageal reflux disease (GERD). Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) using argon plasma coagulation are promising methods. However, no study has compared these two. This study compared the efficacy and safety of the two procedures. This multicenter, retrospective, observational study included 274 patients; 96 and 178 patients underwent ARMA and ARMS, respectively. The primary outcome was subjective symptom improvement based on GERD questionnaire (GERDQ) scores. The secondary outcomes included changes in the presence of Barrett's esophagus, Los Angeles grade for reflux esophagitis, flap valve grade, and proton pump inhibitor withdrawal rates. The ARMS group had higher baseline GERDQ scores (10.0 vs. 8.0, P < 0.001) and a greater median postprocedure improvement than the ARMA group (4.0 vs. 2.0, P = 0.002), and even after propensity score matching adjustment, these findings remained. ARMS significantly improved reflux esophagitis compared with ARMA, with notable changes in Los Angeles grade (P < 0.001) and flap valve grade scores (P < 0.001). Improvement in Barrett's esophagus was comparable between the groups (P = 0.337), with resolution rates of 94.7% and 77.8% in the ARMS and ARMA groups, respectively. Compared with the ARMA group, the ARMS group experienced higher bleeding rates (P = 0.034), comparable stricture rates (P = 0.957), and more proton pump inhibitor withdrawals (P = 0.008). Both ARMS and ARMA showed improvements in GERDQ scores, endoscopic esophagitis, flap valve grade, and the presence of Barrett's esophagus after the procedures. However, ARMS demonstrated better outcomes than ARMA in terms of both subjective and objective indicators.

Current Status and Considerations on Endoscopic Diagnosis and Treatment of Subepithelial Microlesions in the Digestive Tract

The detection rate of subepithelial lesions in the digestive tract, especially microlesions (≤ 1 cm in diameter), has significantly increased. Historically, periodic follow-up or surgical resection has been recommended by scholars. Due to the potential risk of malignancy, regular follow-up carries certain risks, while surgical resection, though effective, is highly invasive with a high risk of complications. With the rapid development of endoscopic techniques, more and more subepithelial lesions in the digestive tract have been successfully treated through endoscopic submucosal dissection and endoscopic full-thickness resection. However, these methods require a high level of skill and are associated with significant costs for surgical instruments and materials. Therefore, it is worth exploring whether a simpler and more efficient treatment can transition patients from observation to proactive treatment. A modified technique combining snare, long transparency cap, and Argon Plasma Coagulation under endoscopy has advantages over traditional methods, such as being simpler to perform, less prone to complications, and more cost-effective. This article reviews the current status and considerations of endoscopic treatment for subepithelial lesions in the digestive tract.

Clinical features and risk factors for colorectal gas explosion during digestive endoscopy and surgery: a systematic review.

Colorectal gas explosion (CGE) is an exceptional but potentially fatal complication of digestive endoscopy or surgery. The role played by bowel preparations and endoscopic or surgical devices in the risk of CGE is still unclear. We conducted a systematic review of the literature to identify risk factors for CGE. We conducted a comprehensive literature search of multiple databases from inception to September 16, 2024 including all reports of CGE according to a systematic review protocol preregistered on the PROSPERO database (CRD42023455049). Additionally, we analyzed all trials that measured explosive gas levels after different bowel preparation strategies. Twenty-nine case reports, three case series, and eleven trials were included. Thirty-six cases of CGE were described, 12 surgical and 24 endoscopic. Perforation and death following CGE occurred in 81% and 14% of patients, respectively. The most common bowel preparations taken before CGE were enemas (42%) and oral preparations (31%), while 28% of patients did not undergo any bowel preparation. Bowel preparation was reported as inadequate in most CGE (solid stool in 65% and poor in 11%). The most frequent devices that triggered CGE were argon plasma coagulation during endoscopy (58%) and the electric scalpel during surgical procedures (75%). Published trials showed that adequate bowel preparation, together with endoscopic insufflation and suction, reduces intestinal levels of hydrogen and methane. CGE predominantly occurs in patients undergoing interventional procedures with inadequate bowel preparation. Achieving optimal bowel preparation, together with endoscopic aspiration, washing, and CO2 insufflation practically abolishes potentially explosive gas concentrations.

An experimental model of endoscopic argon plasma coagulation in liquid medium

The aim of the research was to investigate the effect of argon plasma coagulation on the wall of the gastrointestinal tract in experiment. Material and methods. A method of endoscopic argon plasma coagulation in a liquid medium was developed to eliminate the shortcomings of the standard technology. Rabbits, divided into two groups, were used as experimental animals; the developed technology of argon plasma coagulation in a liquid medium was applied in the treatment group, while the standard technology of argon plasma coagulation was used in the control group. Gastroscopy, with focal application of argon plasma coagulation followed by morphological examination of the coagulation zones after 1 hour, 1 day, 3 days, and 5 days, was performed. Results. Analysis of morphological sections indicates that when using argon plasma coagulation in a liquid medium, the depth of coagulation impact on biological tissues decreases, as well as the severity of inflammatory changes, resulting in faster reparative changes. The obtained results may be of interest for further clinical-experimental research and implementation into clinical practice of modifications of endoscopic argon plasma coagulation.

Unusual partners: a rare cause of small bowel bulges and a common cause of anemia.

A 67-year-old female, without prior medical history, presented to the emergency department due to dizziness and asthenia, where iron deficiency anemia, without visible blood loss, was identified. A previous abdominal computed tomography revealed intestinal pneumatosis of the proximal jejunum and right colon. The upper endoscopy showed non-atrophic gastritis associated with H.pylori infection, which was treated, and the colonoscopy revealed right colic pneumatosis, without other alterations. A small bowel capsule endoscopy was performed, revealing bulging areas of the intestinal wall, lymphangiectasias and angioectasias, in the proximal small bowel. A single balloon assisted anterograde enteroscopy reached the proximal jejunum, showing several areas of bulging with endoscopically normal mucosa, compatible with intestinal pneumatosis. In 3 bulging areas, there were multiple lymphangiectasias and friable punctate angioectasias, which were treated with argon-plasma coagulation and through-the-scope clip with haemostatic success. The procedure was uneventful. After 6 months of follow-up, the patient was asymptomatic, without anemia or iron deficiency.

The use of argon plasma coagulation in ruptured hemorrhagic syndrome (Mallory-Weiss syndrome) complicated by ongoing bleeding

Objective: to evaluate the efficacy and safety of argon plasma coagulation for endoscopic hemostasis in Mallory-Weiss syndrome. Materials and methods: on the basis of a clinical observation of a patient admitted to the emergency department of the State Budgetary Healthcare Institution of the Moscow Region of the Children’s Central City Hospital with complaints of vomiting of scarlet blood, dark stools, weakness, dizziness. The patient underwent emergency EGDS. Results: According to the EGDS data, a linear mucosal rupture was detected in the lower third of the esophagus along the posterior wall with a transition to the stomach cardia along the lesser curvature, about 8-9 cm long (5 cm in the esophagus, 3-4 cm in the stomach), up to 2 cm deep. -3 mm, from the rupture there is a flow of scarlet blood of medium intensity, in the bottom of the defect, fibers of the submucosal and muscular layers were determined. Endoscopic hemostasis was performed: argon plasma coagulation of the rupture of the mucous membrane of the esophagus and stomach. Against the background of endoscopic treatment by argon plasma coagulation in a patient with a long rupture, hemostasis was achieved and surgical treatment was avoided, which could aggravate the condition and lengthen the treatment time. Conclusions: Argon plasma coagulation as a non-contact method of hemostasis has a limited penetration depth and is safer and more effective than other (contact) electrocoagulation methods, where, as a rule, it is difficult to control the depth of exposure. The use of this method improves the efficiency of endoscopic hemostasis, reduces economic costs, and reduces the patient’s stay in bed.

Surgical aspects of treatment of hiatal hernia

Objective: enhancement the outcome of treatment of patients with complicated forms of hiatal hernia (HH) on the base on a devised personal complex approach.Materials and methods: the review was carried out of 204 patients with complicated forms of HH at the age of 17 to 77 years (men — 44%, women — 56.4%). All 204 patients suffered from gastroesophageal reflux disease (GERD). In 53 (26%) cases synthetic mesh implants were used during surgical management. In 38 patients (18.6%) with hiatal hernia and metaplasia of the esophageal mucosa (ESM) exposed to complex treatment, which includes antireflux surgical management and argon plasma coagulation (APC).Results: early postsurgical complications we met more oſten in the group of patients the ones we used mesh. Late postsurgical complications in the group of patients where mesh implants were used according to the indications were met less oſten. when assessing the quality of life according to the questionnaires GERD-HRqL and GSRS, the subjective symptoms of GERD decrease dramatically aſter surgical treatment (in 3 months), continue to decline up to 12 months, aſter which they acquire a constant character. In patients with hiatal hernia, which has become complicated by ESM metaplasia, aſter completing the courses of argonoplasmic coagulation, in all cases, complete regression of the metaplastic epithelium was registered by us.Conclusions: surgical management of complicated forms of HH using video laparoscopic technique based on the developed algorithm is highly effective, which is confirmed by the low quantity of postsurgical complications and a major improvement of the quality of life of patients.

Incidental diagnosis of gastric antral vascular ectasia in a case of chronic kidney disease from Nepal: a case report

IntroductionGastric antral vascular ectasia is an uncommon clinical disease that affects elder people and is characterized by severe chronic upper gastrointestinal bleeding mainly affecting the gastric antrum. It is generally unusual among patients undergoing maintenance hemodialysis for chronic kidney disease.Case presentationHere, we aim to present an uncommon case of incidental diagnosis of the gastric antral vascular ectasia and erosive gastritis in a 71-year-old Hindu male patient belonging to the Gurung ethnicity of Nepal undergoing maintenance hemodialysis due to chronic kidney disease. The patient presented with a history of melena and fatigue. On investigation, a low hemoglobin level of 7.3 gm% was used for blood transfusion. The patient was on regular hemodialysis after admission at our institution. Upper gastrointestinal bleeding was suspected after analyzing patient’s history and investigations. Therefore, an upper gastrointestinal endoscopy was performed that showed linear ectatic punctuate lesions radiating from the body of the stomach to the antrum, and hence, an incidental diagnosis of the gastric antral vascular ectasia was made. Initial fluid resuscitation, iron therapy, and a triple regimen were administered. Proper management with argon plasma coagulation therapy was scheduled at another institution due to lack of respective facilities in our institution.DiscussionGastric antral vascular ectasia is an unusual cause of upper gastrointestinal bleeding, primarily affecting the gastric antrum and pylorus with rare cases affecting the duodenum, jejunum, and gastric fundus. It is generally associated with other chronic disease conditions. Several hypotheses have been proposed for the pathogenesis of gastric antral vascular ectasia, especially its association with chronic kidney disease, as in our case, which is considered to be rare. Management varies from medical to endoscopic interventions to even surgery.ConclusionPrompt proper diagnosis and treatment for the gastric antral vascular ectasia should be sought, as it is frequently misdiagnosed or missed during upper gastrointestinal endoscopy. Our case report presents a case of gastric antral vascular ectasia in chronic kidney disease undergoing maintenance hemodialysis, which is quite uncommon, as literature has suggested the same point.

Endoscopic argon plasma coagulation (APC) vs glucagon-like peptide-1 receptor agonists (ARGLP1) liraglutide and semaglutide for the treatment of weight regain (WR) after bariatric surgery (BS).

Endoscopic argon plasma coagulation (APC) vs glucagon-like peptide-1 receptor agonists (ARGLP1) liraglutide and semaglutide for the treatment of weight regain (WR) after bariatric surgery (BS).

S563 Efficacy and Safety of Argon Plasma Coagulation and Radiofrequency Ablation for the Management of Gastric Inlet Patches: A Systematic Review and Meta-Analysis

S563 Efficacy and Safety of Argon Plasma Coagulation and Radiofrequency Ablation for the Management of Gastric Inlet Patches: A Systematic Review and Meta-Analysis

S5065 Co-Occurrence of Gastric Xanthoma and Numerous Large Hyperplastic Polyps as a Complication of Argon Plasma Coagulation in GAVE

S5065 Co-Occurrence of Gastric Xanthoma and Numerous Large Hyperplastic Polyps as a Complication of Argon Plasma Coagulation in GAVE

Preliminary validation of the virtual bariatric endoscopic simulator

Background and AimsObesity is a global health concern. Bariatric surgery offers reliably effective and durable weight loss and improvements of other comorbid conditions. However, the accessibility of bariatric surgery remains limited. Minimally invasive techniques, including endoscopic sleeve gastroplasty (ESG), have emerged to bridge this gap. To effectively complete the ESG procedure, one requires skill in multiple complex interventional endoscopic maneuvers. This requisite expertise poses challenges for training in this burgeoning field. MethodsWe designed the Virtual Bariatric Endoscopic (ViBE) simulator software to mimic the ESG procedure accurately. It features a detailed simulation of an endoscope equipped with an endoscopic suturing system and a high-resolution stomach, enhancing the visualization of the procedural details. Furthermore, it incorporates performance metrics utilizing a reverse scoring system to evaluate users’ proficiency in tasks such as argon plasma coagulation (APC) marking, suturing, and cinching. To validate the simulator, we conducted a study involving experts and novices at the Indiana University School of Medicine, where participants engaged with the simulation environment in a series of training tasks. ResultsTwelve participants, comprising five experts and seven novices, participated in the study. They were asked to complete a post-questionnaire featuring seven items, rating each on a Likert scale. The APC task realism received the highest score, averaging 3.83. The usefulness of improving endoscopic technical skills averaged 3.08, with the realism of cinching the knot and suturing tasks receiving scores of 3.17 and 3.25, respectively, suggesting a generally positive reception. Automated performance metrics indicated that, on average, experts outperformed novices by 10.83 points. ConclusionThe ViBE simulation strives to replicate the steps of the ESG within a virtual environment. Our primary objective in developing this simulator is to enhance the learning curve for endoscopic suturing and ESG techniques, thereby safely extending these skills to a broader patient base.

Comparing Endoscopic Treatment Modalities for Gastric Antral Vascular Ectasia: Efficacy, Safety, and Outcomes in a Network Meta-analysis.

Gastric antral vascular ectasia (GAVE) is characterized by vascular ectasias accounting for 4% of nonvariceal upper gastrointestinal bleeds, which can range from occult bleeds to severe acute upper gastrointestinal bleeding. In turn, GAVE can lead to severe morbidity and recurrent hospitalization. Current endoscopic treatments for GAVE include argon plasma coagulation (APC), endoscopic band ligation (EBL), and radiofrequency ablation. With this significant burden in mind, a systematic review and network meta-analysis were conducted to compare the efficacy and safety of various modalities in the treatment of GAVE. All studies that involved adults and children with endoscopic characteristics of GAVE undergoing treatment with APC, EBL, radiofrequency ablation, or a combination of 2 treatment modalities were included. There was no statistical difference in the rate of adverse events and the number of red blood cell transfusions across all 3 groups (APC, EBL, and APC + EBL). However, statistical differences were noted for outcomes of bleeding recurrence, length of hospitalization, and change in hemoglobin status. EBL exhibited a significant decrease in bleeding recurrence when compared with APC. Moreover, shorter hospitalization stays were seen in APC + EBL and EBL groups compared with APC, and a beneficial change in hemoglobin status was also more often seen in APC + EBL and EBL groups compared with APC. Based on this study, EBL was found to have superior efficacy when compared with APC for the treatment of GAVE; however, there was no significant difference in rates of adverse events between APC, EBL, and combination therapy.

Argon Plasma Coagulation as a Type of Endoscopic Treatment of the Gastric Antral Vascular Ectasia Syndrome

Argon Plasma Coagulation as a Type of Endoscopic Treatment of the Gastric Antral Vascular Ectasia Syndrome

Persistent Gastrointestinal Bleeding after Aortic Valve Replacement in Heyde's Syndrome.

Heyde's syndrome (HS) represents an association between aortic stenosis and intestinal angiodysplasias, and it has been demonstrated that acquired von Willebrand disease plays a pivotal role in the pathophysiology of this syndrome. In patients with HS, von Willebrand factor deficiency represents an additional risk factor, further contributing to the risk of bleeding and anemia. We present the case of an 86-year-old patient diagnosed with HS and von Willebrand deficiency in 2018. Four years prior, the patient underwent surgical aortic valve replacement. Since then, she has been receiving chronic oral anticoagulation therapy with a vitamin K antagonist. The patient was admitted to the Internal Medicine Clinic due to semi-solid dark stools, diffuse abdominal pain, and asthenia. Upon examination, the patient presented with an altered general status and clinical signs suggestive of anemia. Laboratory findings revealed anemia with elevated INR and aPTT values. Colonic angiodysplasias were identified during a colonoscopy, although no sources of active bleeding were detected. On the 9th day of hospitalization, the patient experienced an episode of lower gastrointestinal bleeding. The pharmacological management was adjusted, and argon plasma coagulation was recommended. Following treatment of the angiodysplastic lesions, the patient's clinical evolution was favorable, with the correction of the anemia.