Effectiveness Of Argon Plasma Coagulation Research Articles

Effectiveness of argon plasma coagulation in the treatment of chronic actinic proctitis

There are two kinds of actinic proctitis--one is acute and self-limited, and lasts about 3 months; the other is chronic and develops months to years after radiation therapy. The incidence of chronic actinic proctitis is about 5-20% of radiated prostate tumors. To evaluate the effectiveness of argon plasma coagulation in the treatment of chronic actinic proctitis. A retrospective search of patients with the diagnosis of actinic proctitis. The number of argon plasma coagulation therapies needed to achieve the symptom resolution was analyzed. We found 22 patients with a diagnosis of actinic proctitis. Nineteen were males (86.7%) and three (13.6%) were females. Nineteen patients (86.4%) had a diagnosis of prostate adenocarcinoma, one had a diagnosis of squamous-cell cervix carcinoma (4.5%), and two had a diagnosis of endometrial carcinoma (9.1%). The mean number of coagulation sessions needed for symptom resolution was 2.58 (absolute range 1-7) with a median of 2 sessions. Multiple treatments are described in the literature. None of them have shown promising results. Our results suggest that argon plasma coagulation is effective in the treatment of this condition, and achieves a rapid and sustained response with few sessions and a good safety profile.

Argon Plasma Coagulation with Submucosal Saline Injection for Gastric Adenoma on Outpatient Basis

Gastric adenoma with low-grade dysplasia (LGD) is a less progressive disease than with high-grade dysplasia; nevertheless, a certain portion of lesions can progress. The purpose of this study was to evaluate the effectiveness of argon plasma coagulation (APC) with submucosa saline injections (APC-SSI) for gastric adenoma with LGD on an outpatient department (OPD) basis. We included 57 patients with 64 lesions of gastric adenoma with LGD. Endoscopic type was flat elevated in 58 lesions and central depressed in 6 lesions. Normal saline was injected into the submucosa under the lesion before APC. APC was performed to the lesion and its surrounding mucosa. After treatment, patients underwent regular endoscopy follow-ups. One case each of pneumoperitoneum and Mallory-Weiss tearing occurred and could be managed with conservative care. One case of overt bleeding occurred after 2 weeks and was treated with APC. After 19.5 months of follow-up, four residual adenomas (6.3%) were found and treated with additional APC-SSI. Fourteen metachronous lesions were noted in eight patients (14.0%). Twelve lesions were adenoma with LGD and two lesions were intramucosal adenocarcinoma. APC-SSI is an effective and safe treatment modality for gastric adenoma with LGD on an OPD basis and it is recommended for patients with risk factors of endoscopic mucosal resection (EMR). After treatment of gastric adenoma, meticulous follow-up endoscopy is recommended for detection of metachronous lesions.

The beneficial effects of argon plasma coagulation in the management of different types of gastric vascular ectasia lesions in patients admitted for GI hemorrhage

Despite different forms of treatment, few studies have been performed on the outcome and prognosis of patients admitted to the hospital because of gastric vascular ectasia (GVE) and upper-GI bleeding (UGIB). There is also little knowledge on the efficacy of argon plasma coagulation (APC) in different subgroups of GVE lesions. This study was designed to evaluate the efficacy of APC in patients admitted to the hospital with UGIB because of GVE. Prospective evaluation of consecutive cases of UGIB because of GVE. Tertiary and university-affiliated hospital. Twenty-nine patients were included and divided into 3 subgroups: focal vascular ectasia lesions (FVE) (n = 10), portal hypertensive gastropathy (PHG) (n = 11), and gastric antral vascular ectasia (GAVE) (n = 8). Patients were followed at 3 months and every 6 months thereafter during a mean of 23.1 months (range 18-37 months). All patients received intensive APC treatment that was repeated, depending on the endoscopic appearance or clinical evaluation. The overall success of APC treatment was 86%, with only one recurrence of UGIB during the follow-up period. The number of APC sessions was 1.2, 2.2, and 2.3, in each subgroup (not significant), with a total number of sessions of 1.9 +/- 1.3. Treatment success was 90% in the FVE group, 81% in the PHG group, and 87.5% in the GAVE group (NS). The rise in hematocrit from baseline values in the overall group and in each subgroup was significant (P > .01). A single-center study and small sample. Endoscopic thermal ablation with APC is effective in managing UGIB and in reducing transfusion requirements in patients admitted for GI hemorrhage because of different endoscopic types of GVE.

Prospective nonrandomized comparison of two modes of argon beamer (APC) tumor desobstruction: effectiveness of the new pulsed APC versus forced APC

Argon plasma coagulation (APC) has become an established noncontact method of tumor palliation in a variety of locations. The present prospective study evaluated a new APC system (APC-2) using amplified power settings and different application modes, such as intermittent energy delivery (pulsed APC) in comparison with the conventional technique (forced APC). A total of 100 patients with esophageal, gastric, or rectal tumors were alternately (but not randomized) enrolled and treated with either pulsed APC (n = 46) or forced APC (n = 54). Parameters to assess the palliative effect were: amount of lumen restoration ((1/3), (2/3), complete), objective planimetry, stenosis length, treatment time, and number of APC sessions. Overall response rate was similar in both groups (pulsed 83 %, forced 87 %), the same was found in the subgroups with different amounts of lumen restoration and for the other objective parameters. However, the tumor debulking effect was achieved in a significantly shorter median treatment time with forced compared with pulsed APC (13.6 vs. 18.2 minutes, P = 0.03), with a similar number of treatment sessions in both groups. Complications also occurred with similar frequency in both groups. There was no significant difference in overall local tumor response between the two modes of APC application. However, data from this nonrandomized study suggest a faster achievement of response with forced APC. A combination of both modes may be superior.

Ablation of Nonneoplastic Barrett's Mucosa Using Argon Plasma Coagulation with Concomitant Esomeprazole Therapy (APBANEX): A Prospective Multicenter Evaluation

Complete reversal of Barrett's epithelium (BE) achieved by treatment with argon plasma coagulation (APC) is variable. The aim of this prospective study was to evaluate the effectiveness of high-power APC in a multicenter trial. In seven study centers, 60 patients (mean age 57, range 27-77) with nonneoplastic BE (length 1-8 cm) were recruited for treatment with high-power APC (90 W) in combination with esomeprazole 80 mg/day. Video endoscopy, chromoendoscopy, and four-quadrant biopsies (4QB) were carried out during baseline endoscopy and regular intervals. The effect of ablation was classified as complete remission (CR), partial remission, or minor response. Fifty-one of the 60 patients completed ablation therapy. Three patients were lost to follow-up (FU). After a mean of 2.6 APC sessions (range 1-5) and a mean FU of 14 months (range 12-32), CR was achieved in 37 of 48 patients (77%). Major complications occurred in five of 51 patients (9.8%). Complete ablation of BE can be achieved in a high percentage of patients even in a multicenter design using high-power APC. However, APC has a relevant morbidity. Therefore, ablation of nonneoplastic BE cannot be recommended generally because incidence of cancer in BE is low.

Comparison of the Hemostatic Effect of Argon Plasma Coagulation and Heat Probe Coagulation for Peptic Ulcer Bleeding: A Prospective Randomized Trial

Bleeding is a serious complication of peptic ulcer. Emergency endoscopy is the most effective diagnostic and therapeutic method in peptic hemorrhage. Endoscopic heat probe coagulation and argon plasma coagulation are considered to be safe and effective in the treatment of bleeding peptic ulcer. The aim of this study was to evaluate the efficacy and safety of argon plasma coagulation and heater probe coagulation in bleeding peptic ulcer. Method: From May 2004 to October 2005 we conducted a prospective randomized trial in 48 patients with peptic ulcer bleeding, in whom a visible vessel or active bleeding was identified. Patients were randomized into two groups, an APC group comprising 24 patients who received argon plasma coagulation (ERBE®, Soering®) and an HP group, comprising 24 patients who received heat probe coagulation(Injection gold probeTM Bipola hemostasis catheters). The bleeding activity was determined according to the Forrest classification. Result: There were no significant differences between the study groups in terms of age, risk factors, initial hemoglobin values, number of patients showing signs of hemodynamic impairment, ulcer location, or bleeding activity. The initial hemostatic rate was 91.7% in the APC group, and 100% in the heat probe group (P = 0.149). After successful initial endoscopic treatment, rebleeding was observed in 2 cases of APC group and 2 cases of heat probe coagulation group, respectively (not significant). Both rebleeding cases were controlled successfully by endoscopic treatment modality. Mean number of hospital days and percentage needing surgery were comparable in both groups. Conclusions: Argon plasma coagulation and heat probe coagulation are equally effective in control of bleeding from peptic ulcer.

The Long Term Therapeutic Effect of Argon Plasma Coagulation of Gastric Adenoma On OPD-Based

Background and Aims: Gastric adenoma is regarded as a precancerous lesion, and endoscopic mucosal resection (EMR) is accepted to be the standard treatment of gastric adenoma. However, it has a risk of procedure-related complications such as bleeding and perforation. Thus, patients have to be admitted to hospital for several days. Argon plasma coagulation (APC) is a non-contact thermal method with coagulation of a limited and predictable depth. The aim of this study is to evaluate the therapeutic effect of APC for the treatment of gastric adenoma with a low-grade dysplasia. Methods and Patients: 65 gastric adenomas with low-grade dysplasia in 59 patients were treated by APC ablation. Male to female ratio was 3.9:1.53 adenomas in 49 patients were followed up, the mean period of follow-up was 27.8 ± 17.8 (range 12-60) weeks. APC ablations was done after submucosal hypertonic saline injection. We used an argon gas flow of 2 l/min at a power setting of 60 W and a maximum ablation time of 15 s/cm2. Follow-up endoscopies were performed 3, 9, 15 months after the procedure and more than 6 biopsy specimens were taken routinely from the ablated site. Results: All lesions were ablated with APC successfully without serious immediate complications such as major bleeding or perforation. Minor bleeding occurred in 3 patients (4.5%) and it could be easily controlled with endoscope. Transient abdominal pain occurred in 11 patients (18.6%) and it was relieved with conservative care. Follow-up endoscopic biopsy at 9 months after the procedure identified two recurrences (3.8%) and four new metachronous gastric adenomas (8.2%) including high grade dysplasia. Conclusions: OPD-based APC appeared to be a safe, effective and less invasive treatment modality for gastric adenoma with a low grade dysplasia without serious complications. Meticulous endoscopic follow-up should be performed for detection of residual, missed, recurrent lesion and metachronous lesion.

アレルギー性鼻炎に対するアルゴンプラズマ凝固療法

We performed argon plasma coagulation (APC) in 64 patients with perennial allergic rhinitis and 115 patients with cedar pollinosis, and investigated the treatment response and degree of satisfaction. With respect to various symptoms and topical findings, 87 to 89% patients with perennial allergic rhinitis responded to APC for 6 months after this therapy. One year after APC, the response rates for nasal discharge and sneezing ranged from 67% to 69%; the treatment response differed among the symptoms. The response rate for each symptom was approximately 50% 2 years after APC. An increasing number of patients required additional irradiation or other treatments between 1 year and 2 years after APC. Furthermore, 65% of the patients with cedar pollinosis responded to APC, and 77% of the patients were satisfied with this therapy.In years with higher pollen dispersion, the response rate was 52%. In years with lower pollen dispersion, the response rate was 92%. The effects on pollinosis depended on pollen dispersion. In one-third of patients who underwent APC the year before lower pollen dispersion was noted, the effects of APC were maintained over the year. When average pollen dispersion is expected, APC should be performed annually. In 18 of 21 patients with cedar pollinosis complicated by Dactylis glomerata pollinosis, the effects of APC persisted until the end of Dactylis glomerata pollen dispersion. In patients with cedar pollinosis complicated by perennial allergic rhinitis, the response rate was similar to that in patients with cedar pollinosis alone; however, satisfaction was lower. The response rate for APC during pollen dispersion was lower than that for APC prior to pollen dispersion. However, there was no difference in satisfaction. APC was useful for perennial allergic rhinitis and pollinosis.

The Effect of Argon Plasma Coagulation on Porcine Liver Tissue Using the New Vio System in Comparison to APC 300 and Nd:Yag Laser

The Effect of Argon Plasma Coagulation on Porcine Liver Tissue Using the New Vio System in Comparison to APC 300 and Nd:Yag Laser

Argon Plasma Coagulation with or without Saline Immersion: Comparative In Vivo Study on Tissue Effects

Background: Isolated reports suggest that argon plasma coagulation (APC) under saline immersion can deliver energy more evenly to a larger area and in a more superficial manner with less risk of perforation. This manner of application has been used in the rectum and bladder. Our aim was to study the effects of APC with saline immersion in vivo compared to conventional APC application in the stomach and at different power settings. Material and Methods: Two 40-45 kg female domestic pigs were used. An ICC 300 machine and end firing probe (ERBE, Marietta, GA) were utilized. APC was endoscopically performed in the gastric antrum at fixed distance from the mucosa with increasing energy levels in regular (R) fashion and under saline immersion (I), in parallel rows. Three to four rows were made for each group in each animal, so that 6-7 samples could be analyzed. The animals were sacrificed immediately after and the treated areas were excised. Diameter was measured with a micrometer and the tissue was then fixed in formalin for histologic study. Depth of thermal injury was established histologically (in relation to wall layer). Depth and diameter were compared between both groups. Results: average diameter (table below; values = mm) was greater in the R group and increased with increasing power settings. Depth was not statistically different between groups at any power setting. A thermal mucosal effect was evident starting at 15 W in both groups. Submucosal injury was identified at 90 W only in the R group. Histologically, the mucosal thermal damage was attenuated along the borders in some samples from the I group. Macroscopically a white uniform coagulum with an erythematous rim was evident along the margins in the I group in contrast to a charred coagulum seen in the R group. Conclusions: These results do not support the theoretical tissue effects from APC performed under saline immersion. APC performed under saline immersion does not appear to have any advantages for clinical use.

The Effect of OPD-Based Argon Plasma Coagulation Treatment for Gastric Adenoma

The Effect of OPD-Based Argon Plasma Coagulation Treatment for Gastric Adenoma Jong Soo Kim, Choong Keun Cha, Ki Myung Lee, Jae Youn Cheong, Kwang Jae Lee, Jin Hong Kim, Sung Won Cho Background and Aims: Gastric adenoma is regarded as a precancerous lesion, and therefore it is advisable to remove it completely when discovered. Endoscopic mucosal resection (EMR) is accepted to be the standard treatment of gastric adenoma. However, it has a relatively high risk of procedure-related complications such as bleeding and perforation, thus patients having to be admitted to hospital for several days. Argon plasma coagulation (APC) is a non-contact thermal method with coagulation to a limited and predictable depth which is suitable for treating mucosal areas. The aim of this study was to evaluate the effectiveness of APC for the treatment of gastric adenoma with a low-grade dysplasia. Methods: The study group comprised of 14 men and 6 women, diagnosed with gastric adenoma with low-grade dysplasia. OPD-based APC ablations were performed after submucosal hypertonic saline injection. We used an argon gas flow of 2 l/min at a power setting of 60 W and a maximum ablation time of 15 s/cm. Follow-up endoscopy was performed 3 months after the procedure and more than 6 biopsy specimens were taken routinely from the ablated site. Results: All lesions were ablated with APC successfully without serious immediate complications such as major bleeding or perforation. Minor bleeding occurred in 2 patients (10%). One case of bleeding occurred during the procedure and the other case occurred 20 days after the procedure, which was easily controlled with endoscopic hemostasis. Abdominal pain occurred in 6 patients (30%). One of them was treated with analgesics and the remaining 5 patients’ symptoms spontaneously improved. In all patients, there was no evidence of recurrence after the first 3 month follow-up examination. Conclusions: OPD-based APC seems to be a safe, effective and less invasive treatment modality for gastric adenoma with a low grade dysplasia without serious complications, although pathologic confirmation is not available. Abstracts

Short-term effect of argon plasma coagulation of the inferior turbinate in patients with perennial nasal allergy

The aim of this study was to clarify the short-term effects of argon plasma coagulation (APC) of the inferior turbinate in patients with perennial nasal allergy. In a retrospective study, 32 patients with perennial allergic rhinitis were treated by inferior turbinate reduction using APC. Grades of nasal stuffiness, rhinorrhea, sneezing, nasal airflow resistance (NAR) and overall seriousness were evaluated before and then 1–4 and 8 weeks after APC. Subjective symptoms were assessed using a questionnaire in which nasal stuffiness, rhinorrhea and sneezing were graded on a four-point scale (severe, moderate, mild and none) using the Severity Criteria of Symptoms of Nasal Allergy issued by the Japanese Society of Allergology. NAR was measured using active anterior rhinomanometry (AAR) at the 100 Pa point; this was deemed to be an objective measurement of nasal obstruction. The numbers of patients examined before and 1–4 and 8 weeks after APC were 32, 31, 25, 17, 18 and 14, respectively. Both nasal stuffiness and NAR were significantly improved 2 weeks after APC, overall seriousness was significantly improved after 3 weeks and rhinorrhea was improved after 4 weeks. Sneezing did not significantly improve during this study. There was no significant change in the grades of the examined parameters during the period between 4 and 8 weeks after APC. The beneficial effects of APC begin to appear within 2 weeks after APC and no further improvement after about 4 weeks.

EFFECT OF ARGON PLASMA COAGULATION IN PATIENTS WITH UPPER GASTROINTESTINAL ACTIVE HEMORRHAGE

Background: Acute upper gastrointestinal hemorrhage is a common and life‐threatening medical emergency. Despite a large number of endoscopic methods for hemostasis, active bleeding lacks an adequate therapeutic remedy. The aim of the present study was to evaluate the hemostatic effect of argon plasma coagulation on upper gastrointestinal active bleeding, especially in comparison with heater probe and pure ethanol injection therapy.Methods: Sixty‐eight patients with 77 lesions presenting active bleeding were treated endoscopically and divided into three groups depending on the procedures, that is, argon plasma coagulation group (27 patients with 32 lesions), heater probe group (20 patients with 22 lesions) and pure ethanol injection group (21 patients with 23 lesions). The three groups were similar with respect to all background variables. Episodes of rebleeding were retreated with the same modality as used previously.Results: The primary hemostatic rate in the argon plasma coagulation group was 81.3%, that in the heater probe group was 77.3%, and that in the pure ethanol injection group was 87.0%. The permanent hemostatic rate in the argon plasma coagulation group was 75.0%, that in the heater probe group was 63.6%, and that in the pure ethanol injection group was 78.3%. When examined in terms of Forrest's criteria, the argon plasma coagulation group in Forrest's type I b and the pure ethanol injection group in type I a showed the highest permanent hemostatic rate.Conclusions: Argon plasma coagulation is most suitable in arresting oozing hemorrhage. If pure ethanol injection therapy is possible, it is more effective than other therapies in the case of spurters.

Argon plasma coagulation in the treatment of hemorrhagic radiation proctitis is efficient but requires a perfect colonic cleansing to be safe

We evaluate prospectively effectiveness, tolerance, predictive factors of failure and complications of argon plasma coagulation (APC) in the treatment of hemorrhagic radiation proctitis (HRP). Twenty-seven patients were treated by APC for HRP. Eight patients needed blood transfusion before APC. Six patients were anti-coagulated and one had severe thrombocytopenia. APC was performed without sedation in 25/27 patients. Before APC treatment, bowel preparation was performed by enema (n = 19 sessions), polyethylene glycol or sodium phosphate (n = 53 sessions). APC treatment was performed every 5 weeks. Effectiveness of APC was based on clinical and endoscopic score and biological status before and after APC treatment. The mean follow-up was 13.6 months (range, 3-31 months). After one to seven sessions of APC (average, 2.66 sessions), twenty-five patients (92%) had no recurrence of bleeding. The bleeding score decreased from 3.03 to 0.42 (P < 0.001) and the endoscopic score from 3.08 to 0.73 (P < 0.001). Out of the eight patients requiring blood transfusion prior to APC sessions, only one required blood transfusion after APC (P < 0.05). One late relapse was observed and successfully re-treated by APC. Side effects were anal or rectal pain (n = 3) and vagal symptoms (n = 2). Three colonic explosions occurred, with perforation leading to surgery in one case. The incidence of bowel explosion was higher after local preparation (3/19 sessions) compared with oral preparation (0/53 sessions) (P < 0.05). No stricture due to APC appeared, even if telangiectasias coagulated during a session were circumferential. Coagulation by APC is an effective and safe treatment of HRP if a complete cleansing preparation is performed to avoid explosion.

Plasma surgery and topical estriol: effects on the nasal mucosa and long-term results in patients with Osler's disease

Objective The study goal was to report on the long-term results and effect of argon plasma coagulation (APC) surgery and topical estriol in patients with Osler's disease who had recurrent epistaxis. Study design In a prospective clinical study, 52 patients underwent APC and estriol application and were followed for 18 months regarding their bleeding frequency and intensity. Patient blood samples were obtained to determine the serum estriol levels. Scanning electron microscopy of the nasal mucosa enabled a better understanding concerning the effect of estriol on the nasal mucosa. Results Eighteen months after treatment, 96% of the patients stated a significantly reduced bleeding frequency and intensity. Under estriol influence, former berry-like telangiectasia of the nasal mucosa was flatter. The serum estriol levels did not increase significantly in any of the patients. No side effects from the use of topical estriol were observed. Conclusion The combined treatment approach with APC and topical estriol significantly reduces epistaxis in Osler's disease. Significance APC and topical estriol have proved to be a promising alternative in the treatment of Osler's disease.

Efficacy and complications of argon plasma coagulation for hematochezia related to radiation proctopathy

Background: Endoscopic treatments effectively control bleeding caused by radiation proctopathy. The aims of this study were to determine the efficacy and side effects of argon plasma coagulation in the treatment of this type of bleeding. Methods: Records of 21 consecutive patients in whom argon plasma coagulation was used to treat hemorrhagic radiation proctopathy were reviewed. Results: Pharmacologic measures had been unsuccessful in 12 patients. Endoscopic treatment had been unsuccessful in 5 patients. All patients were anemic and 4 had received blood transfusions. The mean number of treatment sessions was 1.7, and 10 patients were successfully treated in single session. Rectal bleeding resolved within 1 month of the last treatment in 19 patients, usually on the day of the last procedure. Bleeding resolved 2 months after cessation of therapy in another patient. Short-term side effects occurred in 3 (14%) patients (rectal pain, tenesmus, and/or abdominal distention); long-term complications (rectal pain, tenesmus, diarrhea) developed in 4 patients (19%). Conclusions: Hematochezia caused by radiation proctopathy is effectively controlled by argon plasma coagulation, in some cases after a single treatment session. Treatment may result in protracted bowel symptoms. (Gastrointest Endosc 2002;55:70-4.)

A PROSPECTIVE RANDOMISED TRIAL COMPARING ARGON PLASMA COAGULATION WITH TOPICAL FORMALIN APPLICATION IN THE TREATMENT OF RADIATION PROCTITIS

Argon plasma coagulation (APC) and topical formalin have both been shown to be effective in the treatment of radiation proctitis.Aim To compare APC with topical formalin in the treatment of rectal bleeding due to radiation proctitis in a prospective randomised trial.Methods Nineteen treatment‐naive patients (17 M) with proven radiation proctitis and troublesome rectal bleeding were randomised to receive day‐case APC or 4% topical formalin. A visual analogue scale (VAS) was used to assess rectal bleeding (0–10; 0 = no bleeding, 10 = severe bleeding) and well being (0–10; 0 = very unwell, 10 = very well). Anorectal function (urgency, incontinence) was assessed with the modified Wexner/Cleveland Continence Score (0–24; 0 = normal anorectal function, 24 = complete incontinence with severe urgency). Hemoglobin (Hb) and transfusion requirements were recorded. Treatment was given at 6‐weekly intervals until rectal bleeding had improved to VAS ≤ 2.5.Results [Table, median (range)] The effects of APC and topical formalin were similar, with significant improvement in rectal bleeding after a median of 2 (1–3) treatment sessions. Haemoglobin increased in patients treated with APC. Four patients were transfusion‐dependent before treatment, all of whom did not require transfusions after treatment (three APC, one formalin). Patient well‐being and continence score did not change significantly after either treatment, although a trend was seen in well‐being score after APC. Two patients treated with APC developed minor rectal strictures, which were readily treated with dilatation.Conclusions Argon plasma coagulation and topical formalin are equally effective in reducing rectal bleeding from radiation proctitis. Risk of rectal strictures may be higher after thermocoagulation with APC. APC Pre‐treatment Post‐treatment Formalin Pre‐treatment Post‐treatment Well‐being score 6.8 (5–9.7) 7.5 (5–10) 5.9 (4.9–8.7) 6 (2.5–9.1) Bleeding score 6 (4–7.6) 1.4 (0–2.5)* 5 (4.6–10) 1.5 (0–2.5)* Continence score 7.5 (3–18) 7.5 (0–17) 6 (1–17) 6 (1–13) Haemoglobin (g/L) 120.5 (71–159) 135.5 (82–164)* 143 (82–164) 144 (116–167) Follow‐up (weeks) 45.5 (22–114) 27 (9–100) P &lt; 0.05.

Effectiveness of argon plasma coagulation for gastrointestinal bleeding in children

Effectiveness of argon plasma coagulation for gastrointestinal bleeding in children

Argon plasma surgery for the inferior turbinate of patients with perennial nasal allergy.

Argon plasma coagulation (APC) is a new electrosurgical modality. The advantages of APC are coagulating of the target tissue without contact and the creation of uniformly deep devitalized and coagulated zones. The objectives of the present study were to determine the clinical effects of APC for the inferior turbinate of patients with nasal allergy and to clarify the histological changes in the mucosa after APC. In a prospective study, 95 patients with perennial nasal allergy were treated with APC. Nasal symptoms and intranasal findings were evaluated preoperatively and 1, 3, and 6 months, and 1 year after the APC. Mucosal specimens from the turbinates were examined under light and electron microscopy. Nasal stuffiness was improved in 77 of 79 (97.5%) patients after 1 month, in 50 of 51 (98.0%) patients after 3 months, in 20 of 23 (87.0%) patients after 6 months, and in 9 of 12 (75.0%) patients at 1 year after the APC. Rhinorrhea was improved in 46 of 75 (61.3%) patients after 1 month, in 40 of 51 (78.4%) patients after 3 months, in 16 of 21 (76.2%) patients after 6 months, and in 6 of 10 (60.0%) patients at 1 year after the APC. The sneezing was improved in 32 of 54 (59.3%) patients after 1 month, in 21 of 35 (60.0%) patients after 3 months, in 10 of 14 (71.4%) patients after 6 months, and in 6 of 8 (75.0%) patients at 1 year after the APC. In the intranasal findings, congestion of the inferior turbinate improved in 75 of 76 (98.7%) patients after 1 month, in 49 of 52 (94.2%) patients after 3 months, in 20 of 23 (87.0%) patients after 6 months, and in 7 of 11 (63.6%) patients at 1 year after the APC. The nasal discharge was reduced in 40 of 75 (53.3%) patients after 1 month, in 32 of 52 (61.5%) patients after 3 months, in 15 of 22 (68.2%) patients after 6 months, and in 5 of 11 (45.5%) patients at 1 year after the APC. No patients needed nasal packing after the APC. This is the first report on the clinical effects of turbinate surgery for nasal allergy using APC. APC was useful fer turbinate surgery of nasal allergy, especially for nasal stuffiness and congestion of the turbinate.

The tissue effect of argon plasma coagulation on esophageal and gastric mucosa

Background: Argon plasma coagulation is a diathermy-based non-contact therapeutic endoscopic modality that may have a lower risk of perforation than other tissue ablation techniques. Methods: Its effect was studied on three fresh esophageal and three fresh gastric resection specimens using power settings from 40 to 99 Watts at 90 degrees, with 1 mm separation using pulse durations of 1 and 3 seconds. A scoring system for depth of tissue damage was created and samples were analyzed blindly by a gastrointestinal histopathologist. Results: There was significantly greater damage to gastric tissue using a 3-second (compared with 1-second) pulse (p = 0.003) and marginally significantly greater damage to esophageal tissue using the 3-second pulse (p = 0.053). Tissue damage was related to power setting for gastric (p = 0.031) but not for esophageal tissue (p = 0.065). Only 1 of 42 esophageal samples and 2 of 42 gastric samples examined showed damage extending into the muscularis propria. Conclusions: Deep tissue damage that could lead to perforation was rare with argon plasma coagulation. The depth of gastric mucosal damage increased with increased pulse duration and increasing power settings, and, although the depth of esophageal mucosal damage was marginally related to pulse duration, it was not related to the power setting. (Gastrointest Endosc 2000;52:342–5).