Efficacy Of Argon Plasma Coagulation Research Articles

214 - Efficacy of argon plasma coagulation in managing gastric antral vascular ectasia: a case report

214 - Efficacy of argon plasma coagulation in managing gastric antral vascular ectasia: a case report

Prospective Meta-analysis of Weight Loss Regained and Success Rate of Argon Plasma Coagulation to Suture and Surgery Procedures Post-bariatric Surgery: Status of the Art of Endoscopic Treatment.

This study performed a meta-analysis to compare the safety and efficacy of argon plasma coagulation (APC) concerning suture (SUT) and surgery (SUR). The One-Way tests were applied, with p <0.05 significant. The value of R2 was analyzed (heterogeneity), and the risk of bias of articles was evaluated. A total of 34 studies were found, eight about APC, twenty about SUT, and six about SUR. For the percentage of Weight Loss Regained (%WLR), the means for APC, SUT, and SUR were 19.39 ± 10.94, 26.06 ± 16.71, and 17.05 ± 9.85, and for success rate (%SR), the means were 89.75 ± 16.75, 86.80 ± 11.44, and 76.00 ± 21.57, respectively with p >0.05, with R2 ≥ 50%. The APC proved to be efficient and safe like the other techniques.

Study the Efficacy of Argon Plasma Coagulation or Endoscopic Band Ligation versus Their Companion in Management of Gastric Antral Vascular Ectasia in Cirrhotic Patients

Abstract Background Gastric antral vascular ectasia (GAVE) is a rare and often misdiagnosed cause of upper gastrointestinal bleeding accounts for up to 4% of all non-variceal upper gastrointestinal bleedings. Multiple options are available for the treatment of GAVE including endoscopic, surgical and medical therapies. Aim of the Work The aim of this study to evaluate the effect of APC followed by EBL in comparison to APC or EBL alone for the treatment of bleeding GAVE in cirrhotic patients. Patients and Methods We conducted this study on 45 adult cirrhotic patients with overt or occult bleeding from GAVE. Patients were divided into 3 groups: 15 patients in each group. Group I was treated with APC alone, group II was treated with EBL alone and Group III was treated with APC followed by EBL. Results In the current study, no statistically significant difference was detected between both groups regarding the etiology of liver cirrhosis, clinical presentation, laboratory or ultrasound findings with special emphasis on pre-treatment hemoglobin value, hospitalizations. APC alone was found to was found to be less effective in the treatment of GAVE when compared to both techniques (EBL and the combined therapy) which were effective in the treatment of GAVE and GAVE recurrence. EBL alone was found to require less number of treatment sessions but required more number of rubber bands and. Combined therapy (APC followed by EBL) successfully decreased the number of banding sessions and decreased the number of rubber bands required to treat GAVE. Conclusion Combined therapy (APC followed by EBL) and EBL alone are effective methods in the treatment of bleeding GAVE in Egyptian cirrhotic patients. EBL alone requires less number of treatment sessions but may require a big number of applied rubber bands. Combined therapy (APC followed by EBL) successfully decreased the number of banding sessions and decreased the number of rubber bands required to treat GAVE. So, in mild cases when less number of rubber bands seems to be required, it is advisable to start with EBL alone: while in severe cases where a large number of rubber bands seems to be required, it is advisable to use combination therapy of APC and EBL.

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.

To coagulate, ligate, or both: a randomized study comparing the safety and efficacy of two endoscopic approaches for managing gastric antral vascular ectasia in cirrhotic patients

BackgroundGastric antral vascular ectasia (GAVE) is an uncommon but important cause of gastrointestinal bleeding in cirrhotic patients. Argon plasma coagulation (APC) is the standard therapy for GAVE. Endoscopic band ligation (EBL) is an emerging, safe and effective treatment for GAVE. The best way of applying EBL in the management of GAVE is not clear yet.AimWe aimed to determine the safety and efficacy of APC alternating with EBL versus EBL alone for managing GAVE in cirrhotic patients.Patients and methodsForty cirrhotic patients with bleeding GAVE were randomized to receive either APC alternating with EBL (20 patients) or EBL alone (20 patients) until GAVE lesions are eradicated. Gastroscopy was done 6 months after eradication of GAVE lesions to document recurrence. Cessation of bleeding, rise of hemoglobin level, need for transfusion, hospitalization, complications, number of sessions, and recurrence of GAVE in both groups were statistically analyzed.ResultsPatients in both groups showed significantly high rate of bleeding cessation, improvement in hemoglobin levels, reduction in transfusions, and hospitalizations. There was no statistically significant difference regarding the recurrence of GAVE between the two groups. There were no complications seen in the combined therapy group. Twenty percent of the patients in the EBL group had complications including hypertrophied polyp formation and post-band ulcerations.ConclusionAPC alternating with EBL and EBL alone are effective methods in the treatment of bleeding GAVE. Combined therapy has the potential to decrease the number of banding sessions and the number of rubber bands required to treat GAVE, consequently decreasing the incidence of band-related complications.

Endoscopic treatment of gastric antral vascular ectasia in real-life settings: Argon plasma coagulation or endoscopic band ligation?

The efficacy of argon plasma coagulation (APC) on gastric antral vascular ectasia (GAVE) may be impaired over time and depends greatly on the application settings. Endoscopic band ligation (EBL) may be an alternative, but study on its efficacy is limited. This study aimed to evaluate and compare the clinical efficacy of APC and EBL in treating GAVE. Changes in the need for blood transfusion, number of treatment sessions and hospitalizations were retrospectively assessed in 63 transfusion-dependent patients with GAVE (mean age: 67.1 y, 54.0% female) treated with either APC or EBL (45 and 18 patients, respectively) in four tertiary endoscopic centers. Both methods substantially increased hemoglobin levels and decreased patients' need for a transfusion (22.0 ± 4.0 g/L and -5.62 ± 2.30 units of packed red blood cells [RBC] with APC, and 27.4 ± 6.1 g/L and -4.79 ± 2.46 units of packed RBC with EBL), without a significant statistical difference between the methods. However, fewer EBL sessions were required both for the cessation of need for a transfusion compared with those for the resolution of GAVE lesions (0.90 ± 0.10 vs 1.69 ± 0.31, P = 0.028). Both APC and EBL are effective in GAVE treatment. EBL may be superior in terms of number of treatment sessions, but not in its influence on hemoglobin level and need for transfusion. Further prospective studies with large, homogeneous sample size and standardized APC settings are needed.

Argon plasma coagulation versus cold steel tonsillectomy: a comparison of safety and efficacy

Background: Various tonsillectomy techniques have been introduced as alternatives to cold steel (CS) dissection. The aim of this study was to compare safety and efficacy of Argon plasma coagulation (APC) with CS tonsillectomy, by evaluating: (I) operative time; (II) intraoperative haemorrhage; (III) postoperative pain and (IV) postoperative haemorrhage. Methods: This study was a retrospective analysis of a 5-year prospectively collected database. Five hundred patients who underwent elective tonsillectomies performed by a single surgeon were included in this study (age range 1–57, male/female ratio =0.68, APC group n=232, CS group n=268). Results: APC group had shorter operative time than CS [12.33 min, standard deviation (SD) 0.284 vs. 20.68 min, SD 0.16, P&lt;0.001], and less intraoperative haemorrhage (P&lt;0.001). Intraoperative haemorrhage was described by a grading system: the majority of APC group in grade 1a bleeding (equivalent to 0–2 mL) and majority of CS in grade 2 bleeding (equivalent to 14–65 mL). Pain scores were lower in CS group by only 0.45 on a 10-point scale (P=0.04) and pain profiles over a 2-week postoperative period were similar. There was less secondary postoperative haemorrhage in APC group compared to CS, which was not statistically significant (3.88% vs. 5.22%, P=0.16). Primary haemorrhage did not occur in either group. Conclusions: APC appears to be a safe and efficacious technique for paediatric and adult tonsillectomy. It offers shorter operative time, reduced intraoperative haemorrhage and same postoperative pain experience. Rates of secondary haemorrhage require further evaluation with higher powered studies.

The Efficacy of Argon Plasma Coagulation versus Carvedilol for Treatment of Portal Hypertensive Gastropathy

Background/Aim: Several treatment options have been developed for portal hypertensive gastropathy (PHG); medications and endoscopic management. The aim of this study was to evaluate the efficacy and safety of argon plasma coagulation (APC) versus Carvedilol in treatment of a cohort of Egyptian patients with severe PHG. Methods: A total of 130 patients with severe PHG were enrolled; 10 patients were excluded due to death and failure to complete the treatment sessions accordingly, 120 patients were included. Patients were divided into 2 groups: Group A (n = 52) treated with APC; Group B (n = 68) treated with oral Carvedilol. Success was defined as stabilization of hemoglobin (Hb) over 100 g/dL or Hb increase >10% from pretreatment level and reduction of blood transfusion requirements over the following 3 months after the start of therapy. Upper gastrointestinal endoscopy was performed to assess the degree and site of PHG. APC was conducted to areas with mucosal ectatic vascular lesions. Results: PHG was mostly fundic (36.35%) in APC group and (36.76%) in Carvedilol group (p = 0.56). Throughout follow-up period, there was significant increase in Hb level, serum iron, and serum ferritin with a significant decrease in total iron-binding capacity (TIBC) in APC group as compared to Carvedilol group (p < 0.001). Additionally, there was gradual increase in the mean Hb, serum iron, and serum ferritin and gradual decrease of TIBC in Carvedilol group. Accordingly, there was an overall improvement of iron deficiency anemia (IDA) in both groups; however, it was significantly better in APC group than in Carvedilol group. No major adverse events were detected in both the groups. Conclusion: APC significantly improves IDA and decreases transfusion requirements in patients with severe PHG as compared to oral Carvedilol with small risk of adverse events. Furthermore, the combination of APC and Carvedilol unless contraindicated could have a synergistic effect in controlling severe PHG.

Clinical efficacy of argon plasma coagulation combined with cryotherapy for central airway stenosis caused by lung cancer

BackgroundThis study aimed to study the clinical efficacy of argon plasma coagulation plus cryotherapy for central airway stenosis caused by lung cancer.MethodsThe clinical data of 177 patients with central airway stenosis caused by lung cancer received surgery from June, 2017 to July 2018 were retrospectively analyzed. According to different treatments, 43 patients received cryotherapy were included in the control group, while 134 patients received argon plasma coagulation plus cryotherapy were in the observation group. After propensity score matching, patients in the two groups were in a 1:1 ratio. The Karnofsky score, partial pressure of oxygen (PaO2), arterial oxygen saturation (SaO2), partial pressure of arterial carbon dioxide (PaCO2) and adverse reactions in patients were analyzed one week before and after treatment. Besides, the survival rates of the two groups were compared.ResultsAfter propensity score matching, the baseline data were not significantly different between the two groups. The post-treatment Karnofsky scores in the two groups were significantly higher than those of before treatment, and the post-treatment score of the observation group was higher than that of the control group (all P < 0.05). The post-treatment PaO2 and SaO2 in the observation group were both higher than those of the control group; while the PaCO2 in the observation group was significantly lower than that of the control group (all P < 0.05). In the observation group, the levels of PaO2 and SaO2 were significantly higher, and the level of PaCO2 was significantly lower after treatment than those of before treatment (all P < 0.05). The rates of completely effective and mild effective in the observation group were significantly higher than those in the control group (both P < 0.05). The incidences of bleeding, arrhythmia and fever in the observation group were significantly lower than those in the control group (all P < 0.05). The survival rate was significantly higher in the observation group (72.09%) than in the control group (51.16%).ConclusionsArgon plasma coagulation combined with cryotherapy can significantly alleviate the central airway stenosis caused by lung cancer, reduce the incidence of adverse reactions, and improve prognosis in patients.

Diagnosis and therapeutic strategies for small bowel vascular lesions.

Small bowel vascular lesions, including angioectasia (AE), Dieulafoy’s lesion (DL) and arteriovenous malformation (AVM), are the most common causes of obscure gastrointestinal bleeding. Since AE are considered to be venous lesions, they usually manifest as a chronic, well-compensated condition. Subsequent to video capsule endoscopy, deep enteroscopy can be applied to control active bleeding or to improve anemia necessitating blood transfusion. Despite the initial treatment efficacy of argon plasma coagulation (APC), many patients experience re-bleeding, probably because of recurrent or missed AEs. Pharmacological treatments can be considered for patients who have not responded well to other types of treatment or in whom endoscopy is contraindicated. Meanwhile, a conservative approach with iron supplementation remains an option for patients with mild anemia. DL and AVM are considered to be arterial lesions; therefore, these lesions frequently cause acute life-threatening hemorrhage. Mechanical hemostasis using endoclips is recommended to treat DLs, considering the high re-bleeding rate after primary APC cauterization. Meanwhile, most small bowel AVMs are large and susceptible to re-bleeding therefore, they usually require surgical resection. To achieve optimal diagnostic and therapeutic approaches for each type of small bowel lesion, the differences in their epidemiology, pathology and clinical presentation must be understood.

The efficacy of argon plasma coagulation in the treatment of gastric antral vascular ectasia in Mataria teaching hospital

Background Gastric antral vascular ectasia (GAVE) is characterized by mucosal and submucosal vascular ectasia. It may present with iron-deficiency anemia or gastrointestinal bleeding. Argon plasma coagulation (APC) may be used for treating GAVE. This study aims to evaluate the efficacy and safety of APC in the treatment of GAVE. Patients and methods A total of 30 patients with GAVE and in need of treatment for bleeding or anemia were treated with APC every 2 to 4 weeks until eradication of GAVE or cessation of the patient's initial symptoms. They were then followed up on a monthly basis for recurrence of initial symptoms or blood transfusion and measurement of hemoglobin levels. Follow-up endoscopy was done after 6 months. Results Among the thirty patients who were included in the study, GAVE was associated with underlying cirrhosis in 18 (60%) patients. Indications for treatment were hematemesis and/or melena in 16 (53.3%) patients and iron-deficiency anemia in 14 (46.6%) patients. A total of 78 APC sessions were conducted for the treatment of GAVE (2.6 sessions per patient, range: 1–6 sessions). Successful endoscopic eradication of GAVE was achieved in 11 of 30 patients (36.6%). Seventeen (56.6%) patients showed improvement in the severity of GAVE from endoscopic evaluation with cessation of the patient's initial symptoms, highly significant reduction of blood transfusion, and an improvement in hemoglobin levels (highly significant). Only two (6.6%) patients showed no improvement in the severity of GAVE from endoscopic evaluation with the continuation of the patient's initial symptoms (bleeding). No endoscopy-related adverse events were found during the study period. Conclusion Endoscopic APC is safe and effective in treating GAVE with a significant reduction in the need for blood transfusion and an improvement in hemoglobin levels, but endoscopic eradication rate of GAVE is low (36.6%).

Argon plasma coagulation versus cryotherapy in alleviation of endobronchial obstruction via fiberoptic bronchoscope

Central airway obstruction from malignant or benign endobronchial tumor can result in respiratory failure. Therapeutic bronchoscopy offers effective method in alleviating dyspnea, controlling hemoptysis and improving quality of life. Aim of the workThe aim of our study was to assess safety and efficacy of Argon plasma coagulation (APC) versus Cryotherapy in treatment of endobronchial obstruction. Patients and methodsThis study was conducted at Chest Medicine Department, Mansoura University Hospital. This study included 20 patients with central airway obstruction (15 male and 5 female). They were divided into two groups. Group A treated with APC in addition to chemotherapy in case of malignant airways obstruction. Group B treated with cryotherapy besides chemotherapy in malignant patients. Clinical, radiological, bronchoscopic and functional data were evaluated before and after therapy. ResultsThere was significant improvement in dyspnea, hemoptysis and cough scores in both groups after therapy when compared to pre-treatment state. Spirometric parameters were improved in both groups. Radiological improvement occurred in 6 out of 10 patients in group A, in 4 out of 10 patients in group B. As regards the complications of the procedures, in group A: bleeding in one case, bronchospasm in one patient and pneumomediastinum in one patient. While in group B: 2 patients were complicated with bleeding, one patient with bronchospasm and one patient with respiratory failure. ConclusionBoth APC and cryotherapy were equally safe and effective methods for treating patients with endobronchial obstruction.

Efficacy of argon plasma coagulation in the management of portal hypertensive gastropathy.

Objectives: Evaluation of the outcome and experience in 2 years of management of portal hypertensive gastropathy (PHG) by argon plasma coagulation (APC) in a cohort of Egyptian cirrhotic patients. Methods: This study was conducted over a 2-year period from January 2011 to February 2013. Upper gastrointestinal endoscopy was performed to evaluate the degree and site of PHG. APC was applied to areas with mucosal vascular lesions. Results: In total, 200 cirrhotic patients were enrolled; 12 patients were excluded due to death (n = 6) caused by hepatic encephalopathy (n = 3), hepatorenal syndrome (n = 2), or chronic lymphatic leukemia (n = 1), or did not complete the treatment sessions (n = 6), so 188 patients completed the study. PHG was mainly fundic in 73 patients (38.8 %), corporeal in 66 patients (35.1 %), and pangastric in 49 patients (26.1 %) (P = 0.026). Patients were exposed to APC and received proton pump inhibitors together with propranolol at a dose sufficient to reduce the heart rate by 25 % or down to 55 beats/min. The mean (± standard deviation) number of sessions was 1.65 ± 0.8; six patients needed four sessions (3.2 %), 19 patients needed three sessions (10.1 %), 74 patients needed two sessions (39.4 %), and 89 patients needed one session (47.3 %). Patients with fundic and corporeal PHG required the lowest number of sessions (P = 0.000). Patients were followed up every 2 months for up to 1 year; the end point was a complete response with improved anemia and blood transfusion requirement which was achieved after one session in 89 patients (75.4 %), two sessions in 24 patients (20.3 %) and three sessions in five patients (4.3 %). A complete response was more prevalent in patients with corporeal and fundic PHG (P = 0.04). Conclusions: After 2 years’ experience in managing PHG, we found that a combination of APC and non-selective beta blockers was highly efficacious and safe in controlling bleeding from PHG. In addition, APC alone is rapid, and effective in the control of PHG induced bleeding, especially when beta blockers are contraindicated.

Complication and remission rates after endoscopic argon plasma coagulation in the treatment of haemorrhagic radiation proctitis.

The management of haemorrhagic radiation proctitis is challenging because of the necessity for repeated intervention. The efficacy of argon plasma coagulation has been described before but the optimum treatment strategy remains debatable. This is a review of our experience over a decade treating patients with haemorrhagic radiation proctitis and their follow-up. This is a retrospective review of consecutive patients who underwent argon plasma coagulation for haemorrhagic radiation proctitis between January 2003 and December 2013. The patients were followed up using a prospectively maintained database. Ninety-one patients were included with a mean follow-up of 13.1months. Majoity (n=85, 93.4%) of the patients were female. Mean age at the time of treatment was 58.2 (range 23-87) years old. Majority of the patients (n=73, 80.2%) received radiotherapy for gynaecological malignancies followed by colorectal (n=13, 14.3%) and urological (n=5, 5.5%) malignancies. Mean interval between radiation and proctitis was 13.8 (range 3-40) months. Seventy-nine percent of patients were successfully treated after 1-2 sessions. Seventeen (18.7%) patients experienced self-limiting early complications, and three (3.3%) had late complications of rectal stenosis which was managed conservatively. Severity of bleeding during the initial presentation is an independent factor that predicts the number of sessions required for successful haemostasis (p=0.002). Argon plasma coagulation is a reasonable treatment option in patients with haemorrhagic radiation proctitis with good safety profile. Our study suggests that the number of APC sessions required to arrest bleeding correlates with the severity of bleeding on initial presentation.

Long-term results on the efficacy of argon plasma coagulation for patients with chronic radiation proctitis after conventionally fractionated, dose-escalated radiation therapy for prostate cancer

PurposeThis study was designed to assess the efficacy and outcomes of argon plasma coagulation (APC) in the management of chronic radiation proctitis after conventionally fractionated, dose-escalated radiation therapy (≥7560 cGy). Methods and materialsWe retrospectively reviewed the charts on all patients treated with external beam radiation therapy (minimum dose, 7560 cGy) for histologically confirmed prostate cancer at our institution from 2003 to 2011. Five hundred patients met these criteria; of these, 35 patients (7.0%) developed radiation proctitis necessitating intervention with APC. Indications for APC treatment were either the need for blood transfusions resulting from proctitis-related anemia or refractory bleeding despite medical management. ResultsThe median follow-up from the completion of radiation treatment was 78 months (range, 19-129) and the median follow up from the most recent APC treatment was 56 months (range, 3-112). Fifteen men (42.9%) needed blood transfusions because of proctitis-related anemia. For 19 patients (54.3%), bleeding was controlled after 1 or 2 treatments. Eventual bleeding control was obtained in 30 patients (85.7%). The median number of sessions per patient was 2 (range, 1-13). Post-APC ulceration was noted in 8 cases (22.9%). Two patients (5.7%) developed colovesicular fistulas, with 1 patient dying from this complication. A short interval between treatments (≤35 days) was associated with an increased risk of ulcer or fistula formation. ConclusionsAPC is an effective treatment for patients with medically refractive radiation proctitis after dose-escalated radiation therapy, frequently controlling bleeding after only one or two sessions. However, rectal ulceration is a common complication, along with a small risk of life-threatening toxicity.

577 Efficacy of Argon Plasma Coagulation Performed on Residual Recurrent Tumors Found After Endoscopic Resections of Early Gastric Cancer and Gastric Adenoma and Clinical Characteristics of the Tumors Cured With Single Session of the Treatment

577 Efficacy of Argon Plasma Coagulation Performed on Residual Recurrent Tumors Found After Endoscopic Resections of Early Gastric Cancer and Gastric Adenoma and Clinical Characteristics of the Tumors Cured With Single Session of the Treatment

Long-term Results on the Efficacy of Argon Plasma Coagulation for Patients With Chronic Radiation Proctitis After Dose-Escalated Radiation Therapy for Prostate Cancer

Long-term Results on the Efficacy of Argon Plasma Coagulation for Patients With Chronic Radiation Proctitis After Dose-Escalated Radiation Therapy for Prostate Cancer

COMPARISON OF ARGON PLASMA COAGULATION AND FORMALIN INSTILLATION IN THE TREATMENT OF RADIATION INDUCED HAEMORRHAGIC PROCTOCOLITIS

Background: Radiotherapy is routinely used in the treatment of pelvic malignancies and about 2–5% of these patients develop radiation-induced proctitis or proctocolitis. This complication of radiotherapy is treated in different ways. Two of these treatments, argon plasma coagulation (APC) and formalin instillation, have both been reported as to be successful modalities, but data comparing them are scarce. We conducted this study to compare these two treatment options. Methods: We reviewed the charts of patients who had radiation-induced proctocolitis and who were treated endoscopically at our tertiary care cancer centre with either APC or formalin instillation. Outcomes of the two treatments were compared in terms of bleeding control after the first session of treatment, the number of sessions required and the nal response to therapy. Results: Out of a total of 26 patients presenting with haemorrhagic radiation proctocolitis, 11 were treated with APC and 15 with formalin instillation. Success after the rst session was 53% in the formalin instillation group compared to 18% in the APC-treated group. On repeated sessions, the final response to both treatment modalities was comparable. Conclusion: Efficacy of APC and formalin instillation in the treatment of haemorrhagic radiation proctocolitis is comparable although formalin showed a better outcome after the first session. Key words: Argon plasma coagulation, formalin instillation, proctitis, radiation-induced colitis

Efficacy of argon plasma coagulation in the treatment of radiation-induced hemorrhagic gastroduodenal vascular ectasia

Objective. Radiation-induced hemorrhagic gastroduodenal vascular ectasia (GDVE) is rare but difficult to manage. Argon plasma coagulation (APC) has not yet been evaluated in the treatment of radiation-induced hemorrhagic GDVE. The efficacy of APC in patients with radiation-induced hemorrhagic GDVE has been investigated in this article. Material and methods. Eighteen patients with upper gastrointestinal (GI) bleeding caused by radiation-induced GDVE, including 13 with hepatocellular carcinoma, 3 with pancreatic cancer, and 2 with cholangiocarcinoma, were treated with APC. The efficacy of APC was retrospectively evaluated, based on cessation of macroscopic GI bleeding, resolution or stabilization of anemia and transfusion dependence, endoscopic ablation of almost all vascular lesions, complications, and recurrence. Results. Mean patient age was 59 years (range 42–80 years). The median time from radiation to GDVE diagnosis was 4.6 months (range 3.3–21.5 months). The median number of APC sessions per patient was 2.4 (range 1–4). All 18 patients showed an endoscopic response to APC treatment, with sustained increases in mean hemoglobin level, from 6.6 g/dL (range 2.9–9.5g/dL) to 9.7 g/dL (range 7.1–12.7 g/dL) (p < 0.001), and decreased dependence on transfusion, from 9.1 (range 0–30) to 4.1 (range 0–15) units of packed red blood cells per patient (p = 0.038) after last endoscopic eradication by APC treatment. There were no major procedure-related adverse events or deaths. At a median follow up of 4.7 months (range 0.6–24.5 months), none of the patients experienced recurrence of GDVE. Conclusions. APC showed short-term effectiveness and safety in the treatment of radiation-induced hemorrhagic GDVE.

Feasibility and efficacy of argon plasma coagulation for early esophageal squamous cell neoplasia

We present 19 cases in which argon plasma coagulation (APC) was used as curative initial treatment for 5 low-grade esophageal squamous intraepithelial neoplasias (ESINs), 12 high-grade ESINs, and 2 early esophageal squamous cell carcinomas (ESCCs). Complete response was defined as the absence of tumor from any biopsy taken from the ablated lesion. At follow-up endoscopy 2 - 4 months after APC, 94.7 % of patients had achieved complete response in a single treatment session. Only one patient with high-grade ESIN showed local recurrence. This patient underwent additional APC and showed complete response at 12 months after initial APC. At the 12-month follow-up endoscopy, again 94.7 % had a complete response. The exception was one patient with local recurrence, who underwent additional APC. After the 12-month follow-up endoscopy, no patient showed local recurrence during a median follow-up of 22 months. No stricture requiring endoscopic dilation occurred after the procedure. This study suggests that APC is a feasible and effective treatment modality for ESIN and early ESCC.