Endoscopic Argon Plasma Coagulation Research Articles

Effective treatment of chronic radiation proctitis using radiofrequency ablation

Endoscopic argon plasma coagulation and bipolar electrocautery are currently preferred treatments for chronic radiation proctitis, but ulcerations and strictures frequently occur. Radiofrequency ablation (RFA) has been successful for mucosal ablation in the esophagus. Here we report the efficacy of RFA with the BarRx Halo(90) system in three patients with bleeding from chronic radiation proctitis. In all cases, the procedure was well tolerated and hemostasis was achieved after 1 or 2 RFA sessions. Re-epithelialization of squamous mucosa was observed over areas of prior hemorrhage. No stricturing or ulceration was seen on follow-up up to 19 months after RFA treatment. Real-time endoscopic optical coherence tomography (EOCT) visualized epithelialization and subsurface tissue microvasculature pre- and post-treatment, demonstrating its potential for follow-up assessment of endoscopic therapies.

Endoscopic Argon Plasma Coagulation for the Treatment of Gastric Antral Vascular Ectasia-Related Bleeding in Patients with Liver Cirrhosis

Background and Aim: Gastric antral vascular ectasia (GAVE) is a cause of bleeding in patients with liver cirrhosis. Argon plasma coagulation (APC) is the most used endoscopic treatment for GAVE-related bleeding. Treatment failures have been described in patients with haemorrhagic diathesis; post-procedure complications include haemorrhages and septicaemia. The aim of the study was to evaluate efficacy and safety of APC treatment of GAVE-related bleeding in patients with liver cirrhosis. Methods: Patients included were suffering from GAVE-related bleeding and liver cirrhosis. APC treatment was performed until eradication. Resolution of transfusion-dependent anaemia and evaluation of complications were the primary outcomes. Results: 20 patients (16 Child C and 4 Child B) were enrolled and prospectively followed for a mean period of 28 months. GAVE eradication was achieved in all patients after a median of 3 sessions (range 1–10). Resolution of anaemia was achieved in 18 patients. Six patients had relapse of GAVE after a mean of 7.7 months, successfully retreated by APC. Hyperplastic polyps developed in 3 patients causing active bleeding in 2 cases. Five patients had liver transplants and 1 had a relapse of GAVE after transplantation. Conclusion: APC is an effective and safe endoscopic treatment for GAVE in patients with liver cirrhosis.

Endoscopic Therapy for Barrett's Esophagus

Recent retrospective cohort data and a prospective randomized sham controlled trial have clearly documented the impact of endoscopic ablation therapy on dysplasia and Barrett's esophagus (BE). The clinical indications for ablation of BE includes high-grade dysplasia and intramucosal adenocarcinoma. The techniques of resection of mucosal irregularities and of ablation are reviewed, primarily thermal and photodynamic ablation. Ablation of BE with neoplasia has appropriately entered the clinical arena.

Prospective Randomized Trial of Argon Plasma Coagulation Ablation Versus Endoscopic Surveillance of Barrett’s Esophagus in Patients Treated with Antisecretory Medication

Argon plasma coagulation (APC) has been used to ablate Barrett's esophagus, however, its role in the management of non-dysplastic Barrett's esophagus is uncertain. The purpose of this study is to determine the efficacy of endoscopic argon plasma coagulation (APC) for ablation of Barrett's esophagus in a prospective randomized controlled trial in two university teaching hospitals. Fifty-seven patients using proton pump inhibitor (PPI) medication and with Barrett's esophagus were randomized to undergo either ablation using endoscopic argon plasma coagulation (APC) or ongoing surveillance. Fifty-one patients underwent endoscopy at 12 months. Endoscopic argon plasma coagulation (APC) versus surveillance endoscopy was studied. Endoscopy and histopathological appearances of Barrett's esophagus at 12 months follow-up was also studied. Initially, at least 95% ablation of the metaplastic mucosa was achieved in 25 of the 26 treated patients. At 12 months, 14 of 23 APC patients had at least 95% regression, and nine of 23 had complete regression of Barrett's esophagus. No surveillance patient had more than 95% regression. The length of Barrett's esophagus shortened significantly after APC (mean 3.0 vs. 0.5 cm). Significant regression of Barrett's esophagus follows ablation with APC, although complete regression was achieved in less than half. The role of APC ablation of non-dysplastic Barrett's esophagus remains uncertain.

W1915 Endoscopic Argon Plasma Coagulation for the Treatment of Gastric Antral Vascular Ectasia (GAVE) in Patients with Hemorrhagic Diathesis Due to Liver Cirrhosis

W1915 Endoscopic Argon Plasma Coagulation for the Treatment of Gastric Antral Vascular Ectasia (GAVE) in Patients with Hemorrhagic Diathesis Due to Liver Cirrhosis

Bleeding gastric vascular ectasia treated by argon plasma coagulation: a comparison between patients with and without cirrhosis

Gastric vascular ectasia (GVE) is an uncommon etiology of GI bleeding. GVE can affect not only patients with cirrhosis but also patients with a variety of chronic diseases. The aim of the study was to compare clinical and endoscopic patient characteristics and responses to treatment by argon plasma coagulation (APC) of bleeding GVE between patients with cirrhosis and noncirrhotic patients. Retrospective study of consecutive patients. Between January 2001 and December 2005, 30 patients were treated by APC for bleeding GVE. Clinical and endoscopic features and APC treatment success were compared between patients with cirrhosis (group 1) and noncirrhotic patients (group 2). Endoscopic treatment efficacy was assessed on the recurrence of symptoms after APC. Seventeen patients were cirrhotic and 13 had no cirrhosis. Cirrhotic patients presented more frequently with overt bleeding (65% vs 15%) and noncirrhotic patients with occult bleeding with iron deficiency anemia (35% vs 85%, P= .01). Endoscopy in noncirrhotic patients revealed more frequently a "watermelon" appearance (23.5% vs 76.9%, P= .008). Endoscopic treatment by APC was successful in 83.3% of patients (88.2% vs 76.9%, not significant). Patients from group 2 required significantly more APC sessions to achieve a complete treatment (2.18 vs 3.77, P= .04). APC treatment of bleeding GVE was efficient and safe in cirrhotic and noncirrhotic patients in more than 80% of cases. Noncirrhotic patients required significantly more APC sessions to achieve a complete treatment. An endoscopic watermelon appearance and the use of antiplatelet drugs were associated with failure of APC.

Randomized Trial of Argon Plasma Coagulation Versus Endoscopic Surveillance for Barrett Esophagus After Antireflux Surgery: Late Results

To determine the efficacy of endoscopic argon plasma coagulation (APC) for ablation of Barrett esophagus. APC has been used to ablate Barrett esophagus. However, the long-term outcome of this treatment is unknown. This study reports 5-year results from a randomized trial of APC versus surveillance for Barrett esophagus in patients who had undergone a fundoplication for the treatment of gastroesophageal reflux. Fifty-eight patients with Barrett esophagus were randomized to undergo either ablation using APC or ongoing surveillance. At a mean 68 months after treatment, 40 patients underwent endoscopy follow-up. The efficacy of treatment, durability of the neosquamous re-epithelialization, and safety of the procedure were determined. Initially, at least 95% ablation of the metaplastic mucosa was achieved in all treated patients. At the 5-year follow-up, 14 of 20 APC patients continued to have at least 95% of their previous Barrett esophagus replaced by neosquamous mucosa, and 8 of these had complete microscopic regression of the Barrett esophagus. Five of the 20 surveillance patients had more than 95% regression of their Barrett esophagus, and 4 of these had complete microscopic regression (1 after subsequent APC treatment). The length of Barrett esophagus shortened significantly in both study groups, although the extent of regression was greater after APC treatment (mean 5.9-0.8 cm vs. 4.6-2.2 cm). Two patients who had undergone APC treatment developed a late esophageal stricture, which required endoscopic dilation, and 2 patients in the surveillance group developed high-grade dysplasia during follow-up. Regression of Barrett esophagus after fundoplication is more likely, and greater in extent, in patients who undergo ablation with APC. In most patients treated with APC the neosquamous mucosa remains stable at up to 5-year follow-up. The development of high-grade dysplasia only occurred in patients who were not treated with APC.

Endoscopic argon plasma coagulation for the treatment of hemorrhagic pseudopolyps in colonic Crohn's disease

A 32-year-old woman with a history of colonic Crohn’s disease since 1997, who had been on azathioprine since 2002, presented in April 2003 with sudden-onset hematochezia and a drop in hemoglobin to 6.2 g/dL, but without a clinical flare of her Crohn’s disease. Colonoscopy showed multiple pseudopolyps from the rectum to the splenic flexure, with fresh blood in the colonic lumen. Some of these pseudopolyps had an erythematous and mosaic appearance, but there was no ulceration (Figure [1]). No signs of Crohn’s colitis or active bleeding were observed. Severe bleeding continued on a daily basis and necessitated treatment with 2 units of blood per day to maintain a hemoglobin level higher than 8 g/dL. A colectomy was considered.

Clinical nursing for patients of endoscopic argon plasma coagulation for treatment of Barrett's esophagus

目的 探讨内镜下氩离子凝固术治疗Barrett食管的围术期护理方法.方法 选择2005年3月-2006年12月,经胃镜检查、病理证实的62例Barrett食管患者进行APC治疗,术前除确保仪器设备性能完好外,重点加强患者的心理护理;术中熟练配合医生操作,密切观察患者反应;术后严密观察各种潜在并发症并予以及时处理.结果 本组患者APC治疗均顺利完成,术后仅6例出现轻度胸骨后疼痛,无穿孔、出血等并发症发生.结论 APC是有效治疗Barrett食管的新方法,围术期护理是治疗成功和有效预防及减少并发症的重要保证。

Impact of Endoscopic Argon Plasma Coagulation (APC) Therapy for the Prevention of Recurrence of Acute Gastrointestinal Hemorrhage from Angiodysplasia

Impact of Endoscopic Argon Plasma Coagulation (APC) Therapy for the Prevention of Recurrence of Acute Gastrointestinal Hemorrhage from Angiodysplasia

Barrett’s oesophagus: long‐term follow‐up after complete ablation with argon plasma coagulation and the factors that determine its recurrence

Argon plasma coagulation seems to be a promising technique for ablation of Barrett's oesophagus, yet few long-term efficacy data are available. To report on a long-term follow-up and the factors that determine the recurrence of intestinal metaplasia in a cohort of patients with non dysplastic, intestinal type Barrett's oesophagus, after complete ablation of the metaplastic mucosa with argon plasma coagulation. Ninety-six patients underwent endoscopic argon plasma coagulation with adequate acid suppression obtained through a continuous omeprazole therapy (50 patients) or through laparoscopic fundoplication (46 patients). Complete ablation was achieved in 94 patients who underwent follow-up. Endoscopic and histological examinations were performed every 12 months. The median follow-up of the patients was 36 months (range 18-98). A recurrence of intestinal metaplasia was found in 17 patients (18%), with an annual recurrence rate of 6.1%. Neither dysplasia, nor adenocarcinoma were found during the follow-up. Through the use of logistic regression analysis, previous laparoscopic fundoplication was associated with a reduced recurrence rate of intestinal metaplasia (odds ratio 0.30, 95% confidence interval 0.10-0.93). The long-term recurrence of intestinal type Barrett's oesophagus was low after complete ablation with argon plasma coagulation. The control of oesophageal acidity acid exposure with laparoscopic fundoplication seems to reduce the recurrence rate.

Successful Use of Endoscopic Argon Plasma Coagulation for Patients with Early Gastric Cancer and Diabetes Mellitus

We report on two patients with gastric tumors (early cancer and adema) and diabetes mellitus who were treated with argon plasma coagulation (APC) therapy. Case 1. A 78-year-old woman visited the Nippon Medical School Musashi Kosugi Hospital because of epigastric pain. An early gastric cancer (IIc) in the anterior wall of the gastric antrum was diagnosed on the basis of the results of a gastric endoscopy examination. The patient had had diabetes mellitus for 18 years and had injected insulin (NovoRapid 30 Mix, 72 units/day) by herself everyday for 10 years. Case 2. A 61-year-old man was referred to our hospital because of a gastric tumor. A gastric adenoma in the anterior of the gastric antrum was diagnosed on the basis of the results of a gastric endoscopy examination. The patient had had diabetes mellitus for 12 years and had been taking oral medication for 2 years. Endoscopic APC was performed in both patients to remove the gastric tumors. These patients have been well for 28 months and 30 months, respectively, after undergoing APC treatment. APC therapy appears to be a safe and useful treatment for patients with diabetes and gastric mucosal lesions.

Endoscopic argon plasma coagulation for the management of solid, centrally located lung cancer

Argon plasma coagulation (APC) is one of the interventional pulmonology techniques primarily aimed at the treatment of hemoptysis. It represents a form of non contact electrosurgey that uses ionized argon gas in order to produce electrical current that affects soft tissues. APC is reported to be effective in the treatment of early stage lung cancer, in the treatment of benign granulation tissue surrounding tracheal stents and in palliative treatment of malignant airway obstruction. Major indication for APC is hemostasis in severe hemoptysis, it can also be used as an alternative technique for laser resection or electrocautery, in urgent removal of tumors situated in large airways. The present article reports successful use of APC in the treatment of centrally located squamous cell lung cancer that caused complete right lung atelectasis. The use of APC led to complete reexpansion of the right lung and improvement in dyspnoea and chest discomfort of the patient. Significant improvement was observed in lung function parameters and blood gas analysis. With the use of APC solid tumor was completely removed from the right main bronchus and airway integrity was restored. From this case we can conclude that APC can be safely and successfully used for urgent debulking of malignant central airway obstruction.

Endoscopic Management of Duodenal Obstruction Due to Migrated Biliary Stents

Distal migration of self-expandable metal stents (SEMS) from the bile duct could potentially result in ulceration, bleeding and duodenal obstruction. We describe endoscopic management of two patients with duodenal obstruction from migrated SEMS. Endoscopic argon plasma coagulation (APC) and cap-assisted stent fracture techniques were used to recanalize the lumen. Case 1: A 64 year-old Hispanic male with unresectable pancreatic head carcinoma presented with obstructive jaundice and ascites. Two overlapping SEMS biliary stents and an internal-external drain was placed. Subsequently, the patient developed symptomatic duodenal obstruction as confirmed by Upper GI series (see figure).FigureEndoscopic transection of the migrated segment of the stent with APC was unsuccessful due to the narrow lumen. Using cap assisted endoscopy, the distal end of the stent was brought in the bulb by using an endoloop. The migrated segment of the stent was fractured against the cap of the endoscope by grasping and pulling pieces of the stent with a Pelican forceps, until the stent segment in the lumen was completely cleared. Barium study 2 days later showed a patent C-loop of duodenum, with excellent flow. Patient tolerated oral diet and was discharged from the hospital 24 hrs later. Case 2: A 66 yr-old male with unresectable ampullary cancer treated with SEMS presented with obstructive jaundice and UGI bleeding. Endoscopy revealed a migrated biliary stent impinging against the posterior wall of the duodenum causing ulceration, bleeding and gastric stasis. Endoscopic retrieval of the stent resulted in hemorrhage, which was controlled by embolization of the gastro-duodenal artery. Subsequently, endoscopic transection of the distally migrated segment with APC was performed along with retrieval of the stent wires in piecemeal fashion with a grasping forceps. Patient was able to resume oral diet and was discharged from the hospital 24 hrs later. We conclude that endoscopic removal of migrated biliary stent can be performed safely. [figure 1]

Endoscopic argon plasma coagulation of Marlex mesh erosion after vertical-banded gastroplasty

Marlex mesh erosions may occur as late complications after vertical-banded gastroplasty. Experience with the endoscopic treatment is limited. To describe the use of argon plasma coagulation in the endoscopic treatment of eroded Marlex mesh. Case report. Endoscopy Unit, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA. We describe the endoscopic treatment of eroded Marlex mesh in 2 patients who presented with symptoms of gastric-outlet obstruction. In both cases, argon plasma coagulation was used to break down the eroded Marlex mesh. Fragments were subsequently removed with forceps and electrocautery snares. We did not encounter any complications with this method. The endoscopic treatment resulted in lasting symptomatic improvement in both patients. Our experience is limited to 2 cases. Argon plasma coagulation appears to be a promising option for the endoscopic treatment of eroded Marlex mesh. It allows the fragmentation of large mesh portions and enables subsequent removal with a snare and a forceps. This method can result in symptomatic improvement and may obviate the need for surgery. Further data are necessary to evaluate the safety and the efficacy of this approach.

Gastric Pneumatosis after Endoscopic Argon Plasma Coagulation

Introduction: Endoscopic argon plasma coagulation (APC) is gaining widespread usage but its risk is underreported. Clinical Picture: A 74-year-old man who received radical radiotherapy for gastric carcinoma 6 months ago was admitted for anaemia and maelena. Gastroscopy revealed haemorrhagic radiation gastritis. Endoscopic APC was performed but terminated when he complained of severe epigastric pain. Computed tomography scan showed gastric pneumatosis. Treatment: His pain subsided with a period of overnight rest and observation. Outcome: He continued to have 3 sessions of endoscopic APC at monthly intervals and at 10 months posttreatment, his haemoglobin remained stable at 11.1 g/dL. Conclusions: This case report highlights a complication of gastric pneumatosis and discusses the safe usage of this modality of endoscopic haemostasis. This is to increase cognisance of this potentially fatal complication among endoscopists.

Endoscopic Argon Plasma Coagulation for the Treatment of Portal Hypertensive Gastropathy

Purpose: Argon plasma coagulation (APC) has been used to treat chronic blood loss from gastric antral vascular ectasia. Its role in the management of chronic blood loss and anemia in patients with portal hypertensive gastropathy (PHG) is not settled. The purpose of this study was to evaluate the use of APC for the treatment of chronic blood loss and iron deficiency in patients with PHG. Methods: The study included 30 patients (17 post-menopausal females and 13 males, mean age 50.7 years) with liver cirrhosis, iron deficiency anemia and severe PHG diagnosed endoscopically. All had hemoglobin <10 gm/dl, with no active bleeding from varices within the previous 6 months. 18 patients had obliterated varices following endoscopic therapy, with the last session more than 6 months before inclusion, and 12 patients had varices that had not bled previously (7 grade 1 and 5 grade 2). Patients had APC sessions with multiple brief pulses delivered to all areas of visible angioectasias or red spots. Endoscopy was repeated after 3 weeks, and further sessions were performed as needed. Patients receiving blood transfusion or iron therapy within the preceding 3 months were not included in the study. Response was assessed by change in hemoglobin and serum iron parameters over the following 2 months after completion of the sessions. Results: APC was delivered in 1 session to 24 patients (16 fundal, 5 body, and 3 antral). Six patients had diffuse PHG with ectasia, 5 requiring 3 sessions and 1 patient requiring 4 sessions of APC. Hemoglobin, MCV, serum iron, and tranferrin saturation increased significantly over the following 2 months in all patients. Conclusions: APC is a safe procedure for the management of PHG. Short term result show favorable response in controlling chronic blood loss and iron deficiency. Whether these results are sustained over longer periods is to be evaluated.Table: Mean Hemoglobin & Iron Profile

A CASE OF PYOGENIC GRANULOMA IN THE SIGMOID COLON TREATED WITH ARGON PLASMA COAGULATION

Pyogenic granuloma (PG) with hemorrhagic tendency, is often recognized in the oral mucosa and skin, but rare in the gastrointestinal tract. Only 20 cases have been reported in the gastric mucosa. There have been no reports of gastrointestinal PG treated by argon plasma coagulation (APC). We report here the first case of PG in the sigmoid colon treated by APC. The patient was a 64‐year‐old woman complaining of constipation who was referred to a university hospital of Kochi Medical School. She presented with easily bleeding mucosa, as revealed by a total colonoscopic study in the sigmoid colon. Magnifying colonoscopic examination showed two sessile small polyps in the sigmoid colon. Pathological examination of the biopsy specimens revealed pyogenic granuloma. We treated this lesion by endoscopic APC. No recurrence has been found as of 9 months after APC therapy.

Novel Use of Weerda Laryngoscope to Remove Early Cervical Esophageal Cancer

A 65-year-old man was followed up after endoscopic mucosal resection for esophageal cancer in February 2000. Thereafter, he received endoscopic mucosal resection, radiation therapy, and argon plasma coagulation for recurrent and multiple primary esophageal cancers. On follow-up examination, two additional esophageal cancers were detected by endoscopy in September 2003. One lesion was located 16 cm from the incisor close to the entrance to the esophagus. To preserve the larynx, this lesion was removed by mucosal resection using a Weerda distending operating laryngoscope. This report describes this novel use of a Weerda distending operating laryngoscope to remove superficial cervical esophageal cancer.

Ablative Therapy of Barrett's Esophagus (BE) By Endoscopic Argon Plasma Coagulation (APC)

Ablative Therapy of Barrett's Esophagus (BE) By Endoscopic Argon Plasma Coagulation (APC)