Endoscopic Argon Plasma Coagulation Research Articles

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).

Endoscopic argon plasma coagulation (APC) treatment for dumping syndrome and post-bariatric hypoglucemia in patients with ROUX-EN-Y gastric bypass

Endoscopic argon plasma coagulation (APC) treatment for dumping syndrome and post-bariatric hypoglucemia in patients with ROUX-EN-Y gastric bypass

Recurrent gastric antral vascular ectasia: a single center experience.

Gastric antral vascular ectasia (GAVE) is a rare cause of chronic or acute gastrointestinal bleeding. This condition accounts for ∼4% of upper gastrointestinal bleeding cases. This disease is often associated with systemic diseases, such as liver cirrhosis, chronic kidney failure, autoimmune conditions, diabetes mellitus, hypothyroidism, and cardiovascular diseases. However, its etiopathogenesis remains controversial. We retrospectively reviewed the cases of GAVE treated at our digestive surgery unit. A total of nine patients were identified with a male/female ratio of 1.25:1 and an average age of 75.51 years (SD ± 9.85). All patients underwent endoscopic argon plasma coagulation (APC) treatment. At the time of the review, data on eight patients were available after 36 months of follow-up. APC appears to be safe and effective for hemostasis of bleeding vascular ectasia. Only one (11.1%) patient required surgical intervention due to hemodynamic instability after multiple unsuccessful endoscopic treatments. No intraoperative and postoperative complication or bleeding relapse was experienced. Based on our findings, we concluded that endoscopic APC is technically simple, but requires multiple re-interventions due to the incidence of relapses. Furthermore, larger randomized studies should be conducted to assess the role of elective surgery as the first intervention in stable patients with severe pathology and the timing of surgery after failed endoscopic treatment.

Esophageal bronchogenic cyst treated with submucosal tunneling endoscopic resection: two case reports

IntroductionAlthough esophageal bronchogenic cysts are benign diseases, they may be accompanied by serious complications and have the possibility of recurrence. Therefore, once confirmed, it is necessary to treat the esophagobronchial cyst when the contraindication is excluded. Endoscopic treatment is usually used for lesions with small diameter and shallow origin, and has the advantages of small surgical trauma and risk, which can reduce the psychological burden of patients to a certain extent, help them to recover quickly, and lower hospital costs.Case presentationCase 1 is a 54-year-old Han Chinese man admitted to our hospital who complained of difficulty swallowing in the past 6 months. Case 2 is a 41-year-old Han Chinese man who was hospitalized in the past 3 months due to chest discomfort. Endoscopic ultrasound revealed a hypoechoic cystic lesion arising from the muscularis propria. Submucosal tunneling endoscopic resection was performed using a dual knife, and a cystic mass was observed between the mucosa and the muscular layers of the esophagus. On locating the cyst, an incision was made on the oral side of the lesion for evacuation. The cyst wall was excised using endoscopic argon plasma coagulation. We successfully removed the esophageal bronchogenic cyst lesion in the intrinsic muscle layer using submucosal tunneling endoscopic resection.ConclusionEsophageal bronchogenic cysts are rare in clinical practice and lack specificity in clinical manifestations. Multiple methods can be used to determine the location and nature of the lesion and ultimately determine the treatment plan. Surgical resection and endoscopic treatment are two different treatment methods, and appropriate treatment plans need to be selected on the basis of the origin layer, size, and relationship with the esophagus of the lesion to reduce complications and improve prognosis.

The Effectiveness of Endoscopic Argon Plasma Coagulation (APC) of Dilated Gastrojejunostomy in the Treatment of Weight Regain After Omega Loop Gastric Bypass Surgery

The Effectiveness of Endoscopic Argon Plasma Coagulation (APC) of Dilated Gastrojejunostomy in the Treatment of Weight Regain After Omega Loop Gastric Bypass Surgery

Comparative efficacy of oral drugs for chronic radiation proctitis — a systematic review

BackgroundChronic radiation proctitis (CRP) is a long-term complication of pelvic radiotherapy that manifests as rectal bleeding, diarrhoea, fistula formation and obstruction. Treatments such as endoscopic argon plasma coagulation, hyperbaric oxygen therapy and rectal topical formalin have imposed a significant medical burden on CRP patients. In contrast, oral therapies offer a more accessible and acceptable option for managing CRP. Here, we conducted a systematic review of the efficacy of oral treatments for CRP to assess their potential as an effective and convenient treatment option for this condition.MethodsWe searched the Cochrane Central Register of Controlled Trials, PubMed, Web of Science, China National Knowledge Infrastructure and Chinese VIP in February 2021. We included post-radiotherapy participants with CRP that compared oral medicine alone or in combination with other treatments versus control treatments. The primary outcomes were bleeding, diarrhoea and symptom score. Heterogeneity between studies was checked using Cochrane Q test statistics and I2 test statistics. The Cochrane risk-of-bias tool was used to assess the quality of the included studies.ResultsWe included 10 randomised controlled trials (RCTs) and 1 retrospective study with 898 participants. Three placebo-controlled trials evaluated the effects of oral sucralfate on CRP, with meta-analysis showing no significant different with placebo arm. Four trials on TCM demonstrated significant improvement of symptoms, especially for the 3 trials on oral TCM drinks. Retinyl palmitate and high-fibre diet were found to reduce rectal bleeding. The combination of oral pentoxifylline and tocopherol did not significantly change the process of CRP.ConclusionsOur study implies that oral TCM drinks, retinyl palmitate and a high-fiber diet showed significant improvement in CRP symptoms, but not with the combination of oral pentoxifylline and tocopherol. Further multicentre, larger-scale RCTs are needed to confirm the efficacy and safety of these treatments and optimize treatment strategies, ultimately improving the quality of life for patients with CRP.

Nintedanib-Induced Gastric Antral Vascular Ectasia in Patients With Idiopathic Pulmonary Fibrosis

ABSTRACT Gastric antral vascular ectasia (GAVE) is a rare cause of gastrointestinal bleeding. However, its association with nintedanib use, antifibrotic therapy for idiopathic pulmonary fibrosis (IPF), has not been reported. We present 2 cases of GAVE that were presumed to be secondary to nintedanib use in patients with IPF. Both patients experienced anemia, one of which had hematemesis. GAVE diagnosis was confirmed by upper gastrointestinal endoscopy. Moreover, successful treatment was achieved with endoscopic argon plasma coagulation. These cases highlight the importance of considering GAVE as a potential cause of anemia and upper gastrointestinal bleeding in patients with IPF receiving nintedanib.

A112 Effectiveness of Endoscopic Argon Plasma Coagulation at Gastrojejunal Anastomoses in Weight Loss after Roux-en-Y Gastric Bypass

A112 Effectiveness of Endoscopic Argon Plasma Coagulation at Gastrojejunal Anastomoses in Weight Loss after Roux-en-Y Gastric Bypass

Evaluation of Endoscopic Mucosal Band Ligation for Treatment of Portal Hypertensive Gastropathy in Cirrhotic Patients

Background: Portal hypertensive gastropathy (PHG) is a clinical condition that can lead to chronic gastrointestinal (GIT) hemorrhage in cirrhotic patients, presented by chronic anemia. The diagnosis is based on the endoscopic features. The aim of the study was to evaluate the safety and efficacy of the use of endoscopic mucosal band ligation for treatment of portal hypertensive gastropathy in cirrhotic patients.
 Patients and methods: This prospective study included 80 cirrhotic anemic patients. They divided into four equal groups: Group (A) included patients who were treated with drugs as beta-blockers. Group (B) included patients treated with argon plasma coagulation (APC). Group (C) included patients treated with endoscopic mucosal band ligation and Group (D) included patients treated with combined endoscopic mucosal band ligation and APC in subsequent sessions.
 Results: There was statistical significant decrease in TIBC throughout follow up in the four studied groups. And there was statistical significant increase in Hb, and serum ferritin throughout follow up in the four studied groups.
 Conclusion: after 2nd follow-up in managing PHG, we have found that there is significant increase in Hb, serum ferritin and significant decrease in recurrent GI bleeding among all groups.

ArgoCap – feasibility and safety of a novel over-the-scope device to facilitate endoscopic APC treatment

Introduction Argon plasma coagulation (APC) is an electrosurgical procedure used, among other indications, for treatment of dysplastic Barrett’s mucosa. Homogeneous and safe application can be compromised by varying distances and suboptimal angle of the probe to the tissue. In this study, we present ArgoCap, a novel endoscopic device developed to facilitate endoluminal APC treatment. Objectives of this preclinical study were to assess feasibility and safety and to determine suitable APC settings. Material and methods One-hundred and thirty-two APC treatments of predefined areas using various APC settings were performed ex vivo in the opened porcine esophagus. Depth of thermal injury was assessed histologically. Feasibility of APC treatment in different locations was examined in 20 explanted porcine esophagi and in first in vivo porcine applications. Results APC treatment in all quadrants of the esophagus was feasible. Histologically, thermal effects involving the whole thickness of the mucosa were visible with all settings. APC with pulsed mode resulted in deep thermal damage with all power settings. No lesions of the muscular layer occurred using precise (E8, E9) and forced (10 W, 20 W) mode. Conclusions Esophageal APC using ArgoCap is feasible and safe. The device has the potential to improve APC treatment of larger mucosal areas.

GAVE-синдром как редкая причина трансфузионно-резистентной железодефицитной анемии у женщины пожилого возраста

Antrum vein ectasia or GAVE syndrome, although rare, can lead to bleeding from the upper gastrointestinal tract in 4% of elderly patients. Its main manifestation includes refractory anemia, requiring regular blood transfusions and constant intake of iron supplements. It is diagnosed by presence of longitudinally located ectatic veins of the antrum of the stomach and histological examination data. Standard treatment includes endoscopic argon plasma coagulation. We present a clinical case report of an elderly woman with GAVE syndrome, severe recurrent iron deficiency anemia, and implanted permanent pacemaker. The treatment complexity in this case was presented by underestimating the endoscopic findings in the gastric mucosa at the onset of the disease, which made it difficult to find the source of bleeding, and the presence of a permanent pacemaker in the patient required correction of its work before the argon plasma coagulation procedure.

Efficacy of Endoscopic band ligation versus argon plasma coagulation inGastric Antral Vascular Ectasia management

Efficacy of Endoscopic band ligation versus argon plasma coagulation inGastric Antral Vascular Ectasia management

Comparison of Endoscopic Radiofrequency Ablation and Argon Plasma Coagulation in Patients with Gastric Low-Grade Intraepithelial Neoplasia: A Large-Scale Retrospective Study.

Background Gastric low-grade intraepithelial neoplasia (LGIN) is a precancerous lesion of gastric cancer. Endoscopic therapies represented by radiofrequency ablation (RFA) and argon plasma coagulation (APC) have been applied to treat gastric LGIN in recent years. However, no comparative study examining the effectiveness and safety profiles of RFA and APC has been reported. Methods A single-center, large-scale, retrospective study, including 73 and 50 patients treated with RFA and APC, respectively, was conducted in the First Medical Center of Chinese PLA General Hospital from October 2015 to October 2020, with a two-year follow-up. Effectiveness, complications, operative factors, and other data were assessed. Results At 2 years of follow-up, cure, relapse, recurrence, and progression rates were 90.4%, 9.6%, 9.6%, and 2.7% in the RFA group, respectively, versus 90%, 10%, 12%, and 4% in the APC group, respectively, with no statistically significant differences between the two groups (all p > 0.05). However, the mean lesion size was significantly larger in the RFA group (2.6 ± 1.0 cm) than in the APC group (1.5 ± 0.6 cm) (p < 0.001); there was also a significant difference in the composition ratio of large lesions between the two groups (p < 0.001). No serious postoperative complications showed in either group, and the abdominal pain was the most common symptom in the short term after surgery. Conclusions RFA and APC are both safe and effective destructive therapies for gastric LGIN. RFA is more suitable for flat and large lesions, while APC is more suitable for small lesions, especially those with slight local uplift or depression. An intraoperative submucosal injection is expected to be an effective method for relieving postoperative abdominal pain.

Blue rubber bleb nevus syndrome: A rare cause of chronic gastro intestinal bleed in children

Blue rubber bleb nevus syndrome (BRBNS) is a rare congenital disorder presenting with multifocal venous malformations of the skin, soft tissues, and gastrointestinal (GI) tract. Here, we report a case of a 10-year-old girl who presented with recurrent lower GI bleeding and abdominal pain requiring repeated blood transfusion for 2 years. A contrast computed tomography showed multiple cavernous haemangiomas in the liver, oesophagogastroduodenoscopy and colonoscopy showed multiple hemangiomas from esophagus to large bowel. Her molecular pathology confirmed BRBNS. She underwent endoscopic argon plasma coagulation with uneventful recovery. In spite of a wide range of therapeutic options for the management of BRBNS described in the literature, the efficacy of those available therapies, including surgical excision, is not well established.

S3581 A Rare Case of Fundal Gastric Antral Vascular Ectasia

INTRODUCTION: Gastric antral vascular ectasia (GAVE) is characterized by erythematous patches or spots in either a diffuse pattern exhibiting a honeycomb appearance or linear array also known as watermelon stomach in the antrum. It was first described by Rider et al in 1953. It is a rare but severe cause of upper gastrointestinal (GI) bleeding and is responsible for about 4% of non-variceal hemorrhage. It is typically located in the gastric antrum, however, in rare cases it may present in cardia, duodenum, jejunum and rectum. The involvement of the proximal part of the stomach is very rare and generally located within a diaphragmatic hernia. CASE DESCRIPTION/METHODS: A 44 year-old male with a history of asthma and diabetes mellitus type 2 was seen in the GI clinic with complaints of 6–8 episodes of bright red blood per rectum for 6 weeks and left lower quadrant abdominal pain for 1 week. Review of systems was unremarkable. Vitals and physical examination were normal. Patient presented to the emergency room one week prior to the clinic visit with similar complaints. Lab result revealed hemoglobin of 12.3. Computed tomography of abdomen and pelvis showed sigmoid colon diverticulosis. Colonoscopy was performed which showed four colonic polyps, diverticulosis and no active source of bleeding. Esophagogastroduodenoscopy subsequently revealed Grade A esophagitis, gastric erosions and streaky, long erythematous areas in the fundus, suggestive of watermelon stomach. Mucosal biopsies of gastric mucosa showed no histopathologic abnormality. DISCUSSION: GAVE may present with blood in stool, hematemesis and iron deficiency anemia. 60% of cases are associated with connective tissue disorder; 30% are associated with portal hypertension and cirrhosis; and 10% are associated with chronic renal failure and bone marrow transplantation. Uniquely, this patient had none of these conditions. Gross endoscopic appearance is diagnostic. For uncertain cases, biopsies can be obtained and may show mucosal vascular ectasia, fibrin thrombi, fibrohyalinosis and spindle cell proliferation without signs of inflammation. However, a normal histopathology does not preclude its diagnosis as biopsies may not include full thickness of the mucosa. The primary therapy is Endoscopic Argon Plasma Coagulation. Partial gastrectomy can be considered as a last resort. Although GAVE is predominantly an antral syndrome, it can be seen rarely in other parts of the GI tract as well.Figure 1.: Watermelon appearance of stomach.

An integrated approach to treatment of patients with complicated forms of gastroesophageal reflux disease

Aim. To justify the appropriateness of applying the integrated algorithm of treatment, including the sequential application of conservative antireflux treatment and antireflux surgery, in patients with complicated forms of gastroesophageal reflux disease.&#x0D; Methods. The main group of the study included 554 patients with complicated forms of gastroesophageal reflux disease (erosive esophagitis in 301, peptic stricture in 36, Barrett's esophagus in 90 and a combination of several complications in 127 patients), and the control group included 229 patients with uncomplicated gastroesophageal reflux disease and indications for surgical treatment. At the diagnostic stage, fiberoptic esophagogastroduodenoscopy with chromoendoscopy using a double dye staining technique (Lugol and methylene blue) and biopsies of areas suspicious for metaplasia, as well as a barium contrast multi-positional radiographic examination of the esophagus and gastroesophageal junction were used. At the treatment stage, both groups received conservative antireflux treatment lasting 48 weeks, comprising lifestyle regulation, diet, antisecretory drug therapy (proton pump inhibitors omeprazole or rabeprazole 20 mg orally twice a day, antispasmodic agent domperidone 20 mg orally 3 times a day or itopride 50 mg orally 3 times a day), followed by either laparotomic or laparoscopic antireflux surgery. In the main group, antireflux surgery was supplemented with endoscopic argon plasma coagulation during the postoperative period in the patients with Barrett's esophagus and esophageal bougienage under endoscopic control during the pre- and postoperative period in the patients with a peptic stricture.&#x0D; Results. The frequency of intraoperative [6.3% (95% CI 1.45.8%), p=0.0462] and early postoperative complications [41.5% (95% CI 37.445.7%), p=0.0011] in the main group were statistically significantly higher than in the control group. There was no clinically important difference. Frequency of late postoperative complications in the main group [5.4% (95% CI 3.77.6%)] did not have statistically significant differences from the control (p=0.1239). The integrated algorithm of treatment has proven to be safe with provision for the need to develop measures to reduce the overall incidence of early postoperative complications. Excellent and satisfactory immediate treatment results were achieved in 91.7% (95% CI 89.193.9%), and excellent and satisfactory long-term results were achieved in 91.3% (95% CI 88.793.5%) patients of the main group, and were statistically significantly worse than in the control group, p=0.0008 and p=0.0021 for the immediate and long-term results, respectively. The difference was attributable to the extremely high efficiency of the treatment algorithm in the control group and had no clinical significance.&#x0D; Conclusion. The use of the integrated algorithm of treatment based on the implementation of antireflux surgery is appropriate in all patients with complicated forms of gastroesophageal reflux disease.

P53 Gastric antral vascular ectasia in Sjögren's syndrome?

Abstract Background Gastric antral vascular ectasia (GAVE) is a rare, but severe cause of non-variceal upper gastrointestinal bleeding (UGIB). It commonly manifests as iron deficiency bleeding and associated with liver cirrhosis, chronic renal failure and connective tissue diseases. Many therapeutic options have been proposed, but the first line of treatment for GAVE remains as endoscopic Argon plasma coagulation (APC). At present, there are no clear satisfactory results to opt for medical therapy as an alternative to invasive approach. We present a case of primary Sjögren's syndrome who has developed GAVE and successfully treated with medical therapy. Methods A 68 years old lady was initially referred to Rheumatology with new symptoms of Raynaud’s, affecting her hands and toes. She had dry eyes and mouth, which were managed conservatively. There was no skin change or gastrointestinal symptoms. She had strongly positive ANA with negative ENA and low levels of IgG and IgM. Nifedipine was initiated to control her Raynaud’s symptoms and the diagnosis of Sjogren’s syndrome was made. Eight months following the initial diagnosis, she was found to have iron deficiency anaemia. There was no change in her symptoms or dietary intake. CT colonography revealed no colonic abnormality. Gastroscopy revealed gastric antral vascular ectasia (GAVE) and the patient was treated with endoscopic argon plasma coagulation (APC). This patient underwent second APC after three months as her haemoglobin dropped despite regular iron supplements. We had made a decision to start pulsed cyclophosphamide and methylprednisolone infusion to control her disease activity. Her haemoglobin remained stable for seven months following the last infusion. She then underwent her third APC and another pulsed cyclophosphamide infusion was resumed. Nine months since her last infusion, her haemoglobin dropped once again, and she underwent another APC. In view of her good response to cyclophosphamide infusion, this lady was started on mycophenolate as maintenance. Since the introduction of mycophenolate, we were pleased that this lady’s haemoglobin had normalised, and the iron supplement was no longer required. Results The association of GAVE with Sjögren's syndrome is not commonly known. There were two other case reports of patients with primary Sjögren's syndrome and developed a mild form of GAVE. As patients with GAVE in the absence of cirrhosis are more at risk of active upper gastrointestinal bleeding, they require more frequent endoscopic treatments following initial diagnosis. APC is an effective treatment; however, it is uncomfortable for these patients to experience repeatedly. Conclusion This case has shown the importance of recognition the possible association of primary Sjögren's and GAVE syndrome as a cause of iron deficiency anaemia. The successful medical therapy of GAVE provides a safe alternative for endoscopic APC, however, more evidences are required to prove the significant of the outcome. Disclosures Y. Tan None. A. Gough None.

Endoscopic Argon Plasma Coagulation vs. Multidisciplinary Evaluation in the Management of Weight Regain After Gastric Bypass Surgery: a Randomized Controlled Trial with SHAM Group.

Roux-en-Y gastric bypass is one of the most widely performed bariatric surgeries. However, the relapse of obesity occurs in approximately 20% of patients and enlargement of the anastomosis is one of the factors associated with this relapse. Endoscopic treatment of the anastomosis has been proposed to assist in renewed weight loss. One endoscopic technique is the narrowing of the anastomosis argon plasma coagulation (APC). Evaluate the effectiveness and safety of the endoscopic treatment of an enlarged anastomosis with APC. A randomized controlled study was conducted comparing APC to exclusive multidisciplinary management after weight regain. Forty-two patients were divided into two groups: APC (n = 22) and control (n = 20). After 14months of follow-up with a crossover at 6months, significant improvement in satiety and greater weight loss were found in the APC group and after crossover. APC was associated with significant weight loss [9.73 (7.46, 12) vs. + 1.38 (- 1.39, 2.15)], a reduction in the anastomosis diameter [p < 0.001], early satiation [0.77 (0.44, 1.11) vs. - 0.59 (- 0.95, - 0.23), p < 0.001], and increased quality of life measured using the EQ5D index [p = 0.04] and EQ5D VAS scale [p = 0.04]. Considering total mean weight loss throughout the entire follow-up, weight loss was similar in both groups (13.02kg in the APC and 11.52kg in the control). Treatment of the gastrojejunal anastomosis with APC was effective and safe, with significant weight loss, the return of early satiation, and an improvement in quality of life.

Preliminary clinical analysis of radiation proctitis treated with argon plasma coagulation combined with submucosal injection

Objective To preliminarily evaluate the clinical efficacy of endoscopic argon plasma coagulation (APC) combined with sub-mucosal injection of norepinephrine saline in the treatment of radiation proctitis (RP), especially for refractory RP. Methods Clinical data of 22 RP patients were retrospectively analyzed. The severity of RP was evaluated by a modified endoscopy scoring system (A) or Sherman′s classification (B). The criteria of successful treatment are the improvement of clinical symptoms or the cessation of bleeding (or only occasional traces of blood on the stools that do not need further treatment). Results All 22 patients were successfully treated. Among them, 18 patients (82%) had no bleeding. According to the classification of A, 15 patients (68%) had mild proctitis and 7(32%) experienced severe proctitis. Based on B classification, 9 patients (41%) were categorized as mild proctitis and 13(59%) as severe proctitis. Using the classification of A, the number of treatment sessions was significantly correlated with the endoscopic grade (or endoscopic total score)(Spearman’s r=0.86, P<0.001). Conclusions Preliminary evidence demonstrates that endoscopic APC combined with sub-mucosal injection of norepinephrine saline is not only effective for mild and moderate RP, but also maintains long-term efficacy for refractory RP. Modified endoscopy scoring system (A) assessment is more suitable for clinical application compared with B assessment. Key words: Radiation proctitis/argon plasma coagulation; Radiation proctitis/combined therapy; Treatment outcome

Evaluation of the Efficacy of Adrenaline Injection Versus Argon Plasma Coagulation Either Alone or Combined in Controlling Acute Bleeding Peptic Ulcer

Background and study aim: Evaluating the sequale and outcomes of managing acute bleeding peptic ulcer by using either diluted adrenaline injection or argon plasma coagulation alone versus using both modalities. Materials and Methods: This study was performed over a 1.5-year period from January 2016 to June 2017. Acute bleeding peptic ulcer patients were assigned randomly to either treatment with diluted adrenaline injection (group I), or with an APC application (group II) or treated using both (group III). All groups were compared regarding the rate of initial hemostasis, rate of recurrent bleeding, successful definitive hemostasis, need for emergency surgery and bleeding-related deaths. Results: In total, Session [CurrentTestPartID] patients with acute bleeding peptic ulcer were enrolled randomly in three groups; group I included 20 patients who were treated with endoscopic adrenaline injection, group II included 20 patients and were exposed to Argon plasma coagulation in sessions and group III included 20 patients who were subjected to both modalities. Patients were followed up in ICU and received PPI IV infusion, Endoscopy was performed one week after initial hemostasis, a second look endoscopy was performed in patients who showed recurrent bleeding. Results revealed significant (p<0.05) superior efficacy of both modalities when used together (group III) compared with using either alone as regard inducing initial and permanent hemostasis, controlling rebleeding and minimizing hospital admission days. Conclusion: Using both endoscopic adrenaline injection and argon plasma coagulation as a combined therapy is highly efficacious in managing acute bleeding peptic ulcer than using each alone.