Mean Number Of Treatment Sessions Research Articles

Ultrasound-guided percutaneous cryotherapy of hepatocellular carcinoma

Background Reports on percutaneous cryoablation to treat patients with HCC are sparse in the medical literature. This study aimed to determine the safety and efficacy of percutaneous cryotherapy for unresectable or recurrent hepatocellular carcinoma (HCC). Methods The results of 40 patients with unresectable HCC and 26 patients with recurrent HCC treated with ultrasound-guided percutaneous cryotherapy from January 2006 to June 2009 were retrospectively analyzed. Results We used percutaneous cryotherapy to treat 76 tumors in 40 patients with unresectable and 76 tumors in 26 patients with recurrent HCC. The size of the tumors was 2.8 ± 1.7 cm (mean ± S.D.). The mean number of treatment sessions for unresectable and recurrent HCC were 1.7 and 1.4, respectively. All cryotherapy procedures were technically successful. No procedure-related death was observed. The overall complication rate was 12.1%. Patients with unresectable HCC had 1-, and 3-year overall survival rates of 81.4%, and 60.3%, while the disease-free survival rates at 1 year and 3 years were 67.6% and 20.8%, respectively. Patients with recurrent HCC had 1-, and 3-year overall survival rates of 70.2%, and 28.8%, while the disease-free survival rates at 1 year and 3 years were 53.8% and 7.7%, respectively. Conclusion Ultrasound-guided percutaneous cryotherapy was safe and efficacious in the treatment of unresectable and recurrent HCC. Further randomized trials are needed to compare the safety and efficacy of cryotherapy with other forms of percutaneous treatment so that an unbiased therapeutic strategy can be devised.

Preliminary Results of Cryospray Ablation Trial for Barrettʼs Esophagus with Low versus High Grade Dysplasia

Purpose: Assess the safety, tolerability, and efficacy of cryospray ablation of Barrett's esophagus (BE) with low grade dysplasia (LGD) vs. high grade dysplasia (HGD), and short segment (SSBE) vs. long segment (LSBE). Methods: Prospective open-label trial in patients with esophageal LGD or HGD treated using CryoSpray Ablation System (CSA Medical). Pts received cryospray ablation every 4-6 weeks until complete endoscopic and histologic resolution. Complete response (CR) defined as all biopsies negative for dysplasia and intestinal metaplasia. Partial response (PR) defined as absence of dysplasia. No response (NR) defined as persistent dysplasia. Results: 14 patients have been treated to date (11 male, mean age 72.4, 8 LGD, 6 HGD, mean length 4.9 cm, range 1-12 cm, 6 SSBE, 4 previous EMR). Among 36 procedures performed, there were no strictures, perforations or other serious adverse events. Two pts (both >10 cm length) had small esophageal erosions 4 weeks after cryospray ablation that healed on follow-up EGD. 9 pts are awaiting follow-up EGD or repeat cryospray ablation. 100% (5/5) of pts who have completed the treatment protocol and follow-up had complete endoscopic and histologic response (2 LGD, 3 HGD, 5 SSBE). Mean number of treatment sessions was 1.6 (mean 1.5 for LGD, 1.7 for HGD, range 1-2). 2 pts with HGD had prior EMR then achieved CR after 1-2 sessions of cryospray ablation and had no complications. The only reported symptom post procedure was sore throat. Conclusion: Preliminary data suggests that cryospray ablation is safe, well-tolerated and effective at eradicating Barrett's esophagus. Cryoablation is effective and safe in patients who have had previous EMR. More than 4 wks may be needed for complete healing in pts with BE >10 cm in length. Data regarding response rates are pending for pts with BE >10 cm in length.

Comparison of turbo-PUVA and conventional American-style PUVA in the treatment of psoriatic patients

Ultraviolet (UV)A protective properties of dihydroxyacetone (DHA) have been used as a topical UV-resisting barrier to optimize psoralens and UVA (turbo-PUVA). Starting doses and increments were based on the DHA diffuse reflectance spectroscopy-derived protection factor. To evaluate the efficacy of turbo-PUVA in psoriatic patients using a simpler method for determining starting doses and increments, in comparison to the conventional American-style PUVA photochemotherapy. Thirty psoriasis patients (15 on American-style PUVA and 15 on turbo-PUVA) were evaluated, each receiving PUVA twice weekly. Starting UVA dose was determined according to skin phototype for the American-style PUVA group and according to the patient's skin phototype x DHA SPF 3 in turbo-PUVA group. UVA increments used were 0.5-1.5 J/cm(2) per treatment in American-style PUVA and 25% of the previous dose in turbo-PUVA. Turbo-PUVA group showed a significantly lower mean cumulative dose, a significantly higher psoriasis area and severity index score reduction, lesser mean number of treatment sessions, and less duration of treatment till remission (188.44+/-106.2 J/cm(2), 92.164+/-1.975%, 11.2+/-3.52 session, and 1.4+/-0.44 months, respectively) than conventional American-style PUVA group (255.13+/-18.304 J/cm(2), 74.725+/-10.976%, 30+/-0.00 sessions, and 3.75+/-0.00 months, respectively). Turbo-PUVA is more effective and time convenient for the treatment of psoriasis with less cumulative dose than the conventional American-style PUVA.

Surgical Excision and Immediate Postoperative Radiotherapy versus Cryotherapy and Intralesional Steroids in the Management of Keloids: A Prospective Clinical Trial

Objective: To compare the efficacy and tolerability of surgical excision and radiotherapy with those of cryotherapy and intralesional steroid treatment of keloids. Subjects and Methods: Twenty-six patients with a total of 76 keloids were enrolled in this study. Nineteen patients with 44 keloids underwent surgical excision combined with immediate 12-Gy irradiation (group A) while the remaining 9 patients with 32 keloids received multiple sessions of intralesional steroid treatment after cryotherapy which continued until flattening of lesion(s) occurred (group B). Two patients were included in both treatment groups. All patients were followed up at regular intervals for at least 1 year. Results: In both treatment groups, keloids responded well without any major side effect. While patients of group A were all satisfied, those of group B (with a mean number of treatment sessions of 5.84 ± 2.51) experienced more side effects, a more prolonged course, a higher recurrence rate and less satisfaction. Conclusion: This study showed that surgery plus immediate postoperative irradiation was an effective and relatively safe choice for treatment of keloids. Although cryotherapy combined with intralesional steroids was associated with more side effects and higher relapse rates, it could be a good choice for small and newly formed keloids.

One-Year Results of Reduced-Fluence Photodynamic Therapy for Polypoidal Choroidal Vasculopathy

To report 1-year results of reduced-fluence photodynamic therapy (PDT) for polypoidal choroidal vasculopathy (PCV) in Japanese patients. Prospective interventional case series. In the present study, 28 treatment-naïve eyes of 28 consecutive patients underwent PDT with a reduced laser fluence of 25 J/cm(2). Patients were followed up at baseline and 1 week and 3, 6, 9, and 12 months after PDT. Choroidal perfusion changes were evaluated by indocyanine green angiography (ICGA) and leakage from PCV lesions and exudative changes by fluorescein angiography and optical coherence tomography. Treatment safety was assessed according to visual acuity (VA) and adverse events. The best-corrected VA (BCVA) obtained by Landolt ring tests was converted into the logarithm of the minimal angle of resolution (logMAR). At baseline, the mean logMAR BCVA was 0.45 (geometric mean: 7/20). At 12 months, the mean logMAR BCVA significantly improved to 0.29 (geometric mean: 10/20) (P = 0.0001). The logMAR BCVA was stable or improved by >or=0.2 in 26 eyes (93%) at 1-year follow-up. In 10 eyes with VA better than 20/40 at baseline, the mean logMAR BCVA was significantly improved compared with baseline at 12 months. Although 16 of 28 eyes (57%) showed mild to moderate nonperfusion of choriocapillaris in early ICGA at 1 week, 27 eyes (96%) showed recovery to pretreatment levels at 3 months. Mean number of treatment sessions during the 12 months was 1.3. No severe side effects related to treatment were encountered. Reduced-fluence PDT is an effective treatment for PCV and could improve vision even in eyes with VA better than 20/40.

Improving access to psychological therapies: Phase IV prospective cohort study

To determine the effects of implementing stepped care evidence-based psychological treatments for anxiety and depression in routine practice using a collaborative care implementation model. Observational prospective cohort study/Phase IV field trial. We collected data on depression and anxiety from a prospective cohort of 3,994 consecutive patients referred to the UK Improving Access to Psychological Therapies demonstration site in Doncaster for 12 months from August 2006 using PHQ-9 and GAD-7. We collected demographic and process information including the type and methods of treatments received. We calculated effect sizes, remission, and recovery rates for patients competing treatment and those who dropped out or were considered to be unsuitable. Two thousand seven hundred and ninety-five patients received an assessment, out of which 2,017 received two or more appointments. Out of these, 869 had completed treatment by the census date, 743 remained in treatment, 319 had dropped out, and 85 had been found to be unsuitable. Pre-post treatment effect sizes for anxiety and depression in those patients completing treatment were 1.39 and 1.41, respectively, with post-treatment relative risks of depression and anxiety 0.29 and 0.34. The combined remission and recovery rates were 76% for depression and 74% for anxiety. The mean number of treatment sessions was 5.15 in a mean time of 2 h and 45 min. On an average, patients received at least three of these contacts by telephone. Outcomes are comparable with benchmarked trials, reviews, and routine datasets. Combining low-intensity stepped care psychological treatment with a telephony-based collaborative care organizational system can deliver good clinical outcomes in routine practice.

Ethanol Ablation of Hepatocellular Carcinoma Up to 5.0 cm by Using a Multipronged Injection Needle with High-Dose Strategy

To investigate whether ethanol ablation by using a multipronged needle delivery system (multipronged ethanol ablation) could eradicate hepatocellular carcinoma (HCC) up to 5.0 cm in diameter with a single-session high-dose strategy. The hospital ethics committee approved the prospective study, and each patient provided written informed consent. One hundred forty-one patients (125 men, 16 women; mean age, 53 years; range, 27-76 years) with 164 primary or recurrent HCC ranging from 1.3 to 5.0 cm in diameter (mean, 2.9 cm +/- 0.9) were treated with high-dose multipronged ethanol ablation. Patients were unsuitable for surgery, declined surgery and radiofrequency ablation, or had tumors located at unfavorable sites. Primary technique effectiveness (PTE) (complete ablation within two sessions), local tumor progression (LTP), and complications after the treatment were observed. Twenty risk factors of local effectiveness and complications were analyzed by means of univariate and multivariate analysis. Mean number of treatment sessions was 1.1. The mean volume of ethanol per tumor was 31 mL (range, 8-68 mL). PTE was achieved in 134 (95%) of 141 patients and was significantly associated with tumor pattern (capsulated vs noncapsulated, P = .018). After a mean follow-up period of 25 months, LTP was observed in 16 (12%) of 134 patients, and in nine (56%) patients, LTP occurred in tumors 3.1-5.0 cm in diameter. Alanine aminotransferase level (P = .023) was the independent risk factor for LTP. Three (2%) of 141 patients had major complications. Multipronged ethanol ablation with a high-dose strategy can be used to treat HCC up to 5.0 cm in diameter effectively and safely, often in a single session.

Efficacy of Endoscopic Multi-Site Band Ligation in Eradicating Esophageal Varices

Background/Obiectives: Endoscopic elastic band ligation in eradicating esophageal varices has been shown to be an effective, safe, easy-to-do procedure with few untoward effects. This clinical trial compared the mean number of treatment sessions needed to eradicate esophageal varices and the safety of the Multi-site band ligation (banding 2 sites on the same varix) to those of the Conventional band ligation (banding 1 site on the same varix). Methods: This was a prospective randomized controlled clinical trial. Cirrhotics older than 18 years of age with grade 3 or 4 esophageal varices associated with red color signs were included. The patients had gastric varices, upper gastrointestinal hemorrhage, hepatic encephalopathy, or hepatorenal syndrome, those had been administering with beta blockers or isosorbid mononitrates, those had been treated esophageal varices via endoscopy all were excluded. The patients in the Multi-site band ligation group were ligated two sites on the same varix in the range of 5 cm proximal to Z line, whereas those in the Conventional band ligation group(controlled group) were only ligated one site at the most distal end of each varix. Repeat ligation treatment sessions aimed at eradication of varices were conducted at 14- to 21- day intervals until varices in the distal esophagus were obliterated. Results: 12 patients were enrolled in the Multi-site band ligation group and 9 patients in the controlled group. There were no significant differences between the two groups with regard to age, gender, Child classification, the number and the grade of varices(p>0.05). Varices were eradicated in 11 out of 12 patients in the Multi-site band ligation group and in 7 out of 9 patients in the controlled group (p>0.05). The mean number of treatment sessions needed to eradicate esophageal varices in the Multi-site band ligation group were significantly fewer than those in the controlled group (2 versus 3.85 sessions, respectively) (p=0.01). There were no significant differences between the two groups with regard to complications and adverse effects due to the procedure (p>0.05). Conclusions: Multi-site band ligation was as effective and safe in eradicating esophageal varices as Conventional band ligation was. But, Multi-site band ligation-treated patients achieved eradication of varices with fewer sessions of treatment than those treated with Conventional band ligation.

Outpatient basis extracorporeal shock wave lithotripsy for ureter stones: Efficacy of the third generation lithotripter as the first line treatment

We assessed the efficacy of a third generation extracorporeal shock wave lithotripsy (ESWL) machine for ureter stones using the Dornier Lithotriptor Compact Delta. A total of 471 consecutive ureter stones were treated with ESWL using the Dornier Lithotriptor Compact Delta from December 2001 on an outpatient basis. Four hundred and one cases were followed up at least once after the procedure and were included in this study. All of the cases, except one patient who was three years old, were treated without anesthesia, and the procedure was principally performed on outpatient basis. The overall stone free rate was 94.5% and the mean number of treatment sessions was 1.23. The stone free rates were compared considering various clinical factors and significant differences were observed in the stone length, the stone location and the sex in univariate analysis. However, only the stone length maintained a statistically significant impact in multivariate analysis and the stone free rates were 91.2% and 98.0% respectively in larger stones (length 10mm) and smaller stones (length < 10mm) (p = 0.004). In mid-distal stones, the stone free rate was higher than that of proximal stones (97.5% vs 92.6%, p = 0.04) and not affected by stone length. Extracorporeal shock wave lithotripsy performed by the third generation machine achieved an excellent stone free rate with a relatively small number of treatment sessions. This procedure is strongly recommended as the first line therapy for all ureter stones including mid-distal ones.

Clinical usefulness of transpapillary removal of common bile duct stones by frequency doubled double pulse Nd:YAG laser

To study the efficacy and the safety of laser lithotripsy without direct visual control by using a balloon catheter in patients with bile duct stones that could not be extracted by standard technique. The seventeen patients (7 male and 10 female; mean age 67.8 years) with difficult common bile duct (CBD) stones were not amenable for conventional endoscopic maneuvers such as sphincterotomy and mechanical lithotripsy were included in this study. Laser wavelengths of 532 nm and 1064 nm as a double pulse were applied with pulse energy of 120 mJ. The laser fiber was advanced under fluoroscopic control through the ERCP balloon catheter. Laser lithotripsy was continued until the fragment size seemed to be less than 10 mm. Endoscopic extraction of the stones and fragments was performed with the use of the Dormia basket and balloon catheter. Bile duct clearance was achieved in 15 of 17 patients (88%). The mean number of treatment sessions was 1.7 +/- 0.6. Endoscopic stone removal could not be achieved in 2 patients (7%). Adverse effects were noted in three patients (hemobilia, pancreatitis, and cholangitis). The Frequency Doubled Double Pulse Nd:YAG (FREDDY) laser may be an effective and safe technique in treatment of difficult bile duct stones.

Endoscopic Balloon Dilatation for Anastomotic Stricture Developed after Surgery for Colorectal Cancer

Purpose: This study was to evaluate the safety and efficacy of endoscopic balloon dilatation for anastomotic strictures that developed after colorectal cancer (CRC) operations. Methods: Between Jan. 2001 and Dec. 2006, 18 patients (12 men, 6 women) who underwent endoscopic balloon dilatation for anastomotic strictures that developed after CRC operation at the Center for Colorectal Cancer, National Cancer Center, were enrolled, and their medical records were reviewed retrospectively. The median distance from the anal verge to the stricture was 10 cm (range, 3~40 cm). Dilatations were performed using through-the-scope balloons with diameters of 18 to 20 mm on inflation. Results: The overall success rate of endoscopic balloon dilatation was 94.4% (17 patients). The mean number of treatment sessions per patient was 1.9 (range, 1~7). Of the 17 patients treated successfully, 11 patients (64.7%) required only one dilatation, 4 patients (23.2%) required 2 dilatations, and two patients (11.8%) required 7 dilatations. Failure of balloon dilatation occurred in one patient. No complications occurred. Conclusions: Endoscopic balloon dilatation of anastomotic strictures after a CRC operation is safe and efficient.

Efficacy and Safety of Great Saphenous Vein Sclerotherapy Using Standardised Polidocanol Foam (ESAF): A Randomised Controlled Multicentre Clinical Trial

To assess the safety and efficacy of sclerotherapy of the great saphenous vein (GSV) comparing standardised polidocanol foam to liquid polidocanol in a randomised controlled trial (RCT). A multicentre randomised controlled clinical trial was carried out in which saphenous trunks were treated by sclerotherapy. 106 patients with primary varicose veins due to an incompetent GSV were treated with either standardised 3% polidocanol foam or 3% liquid polidocanol. The primary efficacy criterion was elimination of reflux (<0.5 sec) measured 3 cm below the sapheno-femoral junction (SFJ) by duplex ultrasonography 3 months after the last injection. A significantly greater number of patients were successfully treated by foam sclerotherapy resulting in 69% elimination of reflux compared to 27% patients treated with liquid sclerosant. The secondary endpoints of vein occlusion, reflux time, refilling time and patient satisfaction also improved significantly more in the foam group. The mean number of treatment sessions was 1.3 in the foam group compared to 1.6 in the liquid group. Differences between study centres occurred with a mean of 96% reflux elimination in 6 centres versus 39% in 4 other centres. Centres with a high response rate injected a higher mean volume (4.3 vs. 3.6 ml) in the first session in a vein with a smaller diameter (7.5 mm vs. 8.4 mm). No difference in adverse drug reactions was observed between treatment groups. Standardised 3% polidocanol foam is more efficient and equally safe compared to 3% liquid polidocanol for treatment of GSV. In comparison to other studies a relatively small volume was injected into relatively large veins.

Sonographically Guided Intratendinous Injection of Hyperosmolar Dextrose to Treat Chronic Tendinosis of the Achilles Tendon: A Pilot Study

Chronic tendinosis of the Achilles tendon is a common overuse injury that is difficult to manage. We report on a new injection treatment for this condition. Thirty-six consecutive patients (25 men, 11 women; mean age, 52.6 years) with symptoms for more than 3 months (mean, 28.6 months) underwent sonography-guided intratendinous injection of 25% hyperosmolar dextrose every 6 weeks until symptoms resolved or no improvement was shown. At baseline and before each injection, clinical assessment was performed using a visual analogue scale (VAS) for pain at rest (VAS1), pain during normal daily activity (VAS2), and pain during or after sporting or other physical activity (VAS3). Sonographic parameters including tendon thickness, echogenicity, and neovascularity were also recorded. Posttreatment clinical follow-up was performed via telephone interview. Thirty-three tendons in 32 patients were successfully treated. The mean number of treatment sessions was 4.0 (range, 2-11). There was a mean percentage reduction for VAS1 of 88.2% (p < 0.0001), for VAS2 of 84.0% (p < 0.0001), and for VAS3 of 78.1% (p < 0.0001). The mean tendon thickness decreased from 11.7 to 11.1 mm (p < 0.007). The number of tendons with anechoic clefts or foci was reduced by 78%. Echogenicity improved in six tendons (18%) but was unchanged in 27 tendons (82%). Neovascularity was unchanged in 11 tendons (33%) but decreased in 18 tendons (55%); no neovascularity was present before or after treatment in the four remaining tendons. Follow-up telephone interviews of the 30 available patients a mean of 12 months after treatment revealed that 20 patients were still asymptomatic, nine patients had only mild symptoms, and one patient had moderate symptoms. Intratendinous injections of hyperosmolar dextrose yielded a good clinical response--that is, a significant reduction in pain at rest and during tendon-loading activities--in patients with chronic tendinosis of the Achilles tendon.

Long-term outcome of trans-scleral diode laser cyclophotocoagulation in refractory glaucoma

Background:Long-term outcome and complications of diode laser cyclophotocoagulation (DCPC) may be important, since eyes, once treated with DCPC, are less likely to be subjected to other types of interventions in...

Prospective evaluation of a new high-power argon plasma coagulation system (hp-APC) in therapeutic gastrointestinal endoscopy

Objective. The aim of this study was to prospectively evaluate a new high-power argon plasma coagulation system (hp-APC) in therapeutic gastrointestinal (GI) endoscopy. Material and methods. From February to June 2005, 216 patients (167 M (77.3%), mean age 66 years) underwent treatment with hp-APC in a total of 275 sessions. Main indications were additive ablation therapy in Barrett's esophagus, palliative treatment of esophageal cancer, gastric polyps/carcinomas, angiodysplasias, Zenker's diverticula, and duodenal adenomas. The new hp-APC device (VIO 300 D with APC 2) was used (15–120 W) in upper GI endoscopy, push-enteroscopy, and double-balloon enteroscopy. Results. The mean number of treatment sessions required was 1.7 (1–5). For palliative tumor ablation in the esophagus, the number of sessions was 2.3 (1–5). Minor complications (pain, dysphagia, neuromuscular irritation, asymptomatic gas accumulation in the intestinal wall) were observed in 29/216 patients (13.4%). Major complications (perforation, stenosis occured) in 2 patients (0.9%). Conclusions. Hp-APC appears to be safe and effective in the treatment of various GI condition using different types of endoscopes including double-balloon enteroscopy. Because of the low number of treatment sessions required, hp-APC could be used as an alternative to Nd:YAG laser treatment in tumor debulking.

Comparative Results of Extracorporeal Shock Wave Lithotripters with Three Kinds of Shock Wave Generator

was lower in group C than in groups A and B. According to the location, group C had a lower success rate than groups A and B for renal stones, while there were no differences between the three groups in the treatment of other stone locations. The number of treatment sessions for group A was greater than those for groups B and C (group A, 3.83; group B, 1.85; group C, 1.93). Many more sessions were required for group A in comparison with groups B and C in case of renal stones, ureteropelvic junction and upper ureteral stones. The number of sessions for group B was the least for lower ureteral stones. Complications, including stein- strasse, fever, perirenal hematoma and hematuria, were detected in groups A, B and group C at 10, 15.3 and 7.1%, respectively. Conclusions: There were no differences in the success rates between the three extracorporeal shock wave lithotripters using a shock wave gener- ator. The mean number of treatment sessions was most with the pie- zoelectric type; whereas, complications were most prevalent with the electromagnetic type. (Korean J Urol 2007;48:54-60) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

PR_277: Electric Stimulation for Dysphagia Following Stroke: Pilot Data

Objective: To compare the effectiveness of electric stimulation with traditional dysphagia treatment following an acute stroke. Design: Prospective, randomized clinical trial. Setting: Free-standing rehabilitation hospital. Participants: Acute stroke patients (<6wk) with dysphagia divided into 2 groups: group 1 (electric stimulation): n=6; 5 men, 1 woman; mean age ± SD, 61±10.7y; mean days post stroke, 23d; and mean number of treatment sessions, 8.33; and group 2 (traditional dysphagia treatment): n=5; 3 men, 2 women; mean age, 77.2±6.4y; mean days poststroke, 19.8d; and mean number of treatment sessions, 10.

An inhalation sedation patient profile at a specialist paediatric dentistry unit: a retrospective survey

To report on the characteristics, treatment, attendance, scheduling and duration of treatment sessions of child patients attending a specialist paediatric dental hospital service for inhalation sedation. A retrospective study was carried out of all 88 patient case notes of inhalation sedation recipients between September 2004 and March 2005. The recorded data included: child's age, gender and level of social deprivation together with the details of the treatment that was undertaken, the time between the first and current/last sedation appointment and the total number of appointments attended, cancelled and missed. Twenty of the subjects were excluded giving a sample of 68; 51% male, mean age at start of treatment 9.8 years (range 4 to 15) and mean age at end of treatment 10.6 years (range 4 to 16). Of these children 35 (51%) were socially deprived. In respect to treatment, 29% had extractions, 22% endodontics, 81% restorations and 25% fissure sealants. In respect to the number of quadrants that had teeth requiring treatment; 26.5% had one, 25% two, 22% three and 26.5% four. The mean number of treatment sessions required was 4.4 with a mean duration between first and last appointments of 9.5 months (range 0.25 051). There were 27% of appointments cancelled, while 12% of patients failed to keep their appointments. Although over half of the children treated under inhalation sedation came from socially deprived areas, attendance was reasonable and the majority required less than 5 appointments for treatment completion. The treatment provided was variable not only in respect to the procedures but also to the number of quadrants treated.

Safety and efficacy of a new high power argon plasma coagulation system (hp-APC) in lesions of the upper gastrointestinal tract

Background The aim of this study was to analyze safety and efficacy of a new high power argon plasma coagulation system in the upper gastrointestinal tract. Methods Data of 215 patients treated with a high power argon plasma coagulation system in the upper gastrointestinal tract 04/2003–01/2004, using a VIO APC device (VIO 300 D with APC 2; Erbe Elektromedizin, Tübingen, Germany; pulsed argon plasma coagulation, 20–120 W), were reviewed and analyzed. Indications were as follows: additive ablation therapy in curative treatment of early Barrett's cancer (122 patients); palliative treatment of oesophageal cancer ( n = 27); gastric adenoma/carcinoma ( n = 19); Zenker's diverticulum ( n = 8); and other. In 190/215 patients (149 males; mean age 67 years), the data were completely analyzable. Minor and major complications were evaluated. Results Minor complications (odynophagia, pain, fever) occurred in 24/277 sessions (8.7%); major complications (stenosis) in 3/277 sessions (1.1%) using at least 50 W. No perforation or bleeding occurred. The mean number of treatment sessions required was 1.46 (1–7); in the palliative treatment of oesophageal cancer, it was 2.5 (1–5). Conclusions The high power argon plasma coagulation system was effective and safe in various gastrointestinal conditions. Due to it's high effectiveness and a low number of sessions required in tumour debulking, this high power argon plasma coagulation system might be used as an alternative to Nd:YAG laser.

Prospective Evaluation of a New High Power Argon Plasma Coagulation System (VIO APC) in Gastrointestinal Endoscopy: Experience with 216 Patients

Prospective Evaluation of a New High Power Argon Plasma Coagulation System (VIO APC) in Gastrointestinal Endoscopy: Experience with 216 Patients Hendrik Manner, Andrea May, Thomas Rabenstein, Lars Nachbar, Oliver Pech, Markus D. Enderle, Christian Ell Background: We sought to evaluate the safety and efficacy using a new high power argon plasma coagulation system (hp-APC) in the gastrointestinal tract.Methods: From 02/2005 to 06/2005, 216 patients (167 males (77.3%); mean age 66 G 11 years) were treated using hp-APC in a total of 275 sessions. In various indications (additive ablation therapy in curative intention in early Barrett’s cancer (132 patients); palliative treatment of esophageal cancer (n Z 20); gastric polyps/cancer (n Z 17); angiodysplasia (n Z 16); Zenker’s diverticulum (n Z 8); duodenal adenomas (n Z 7); and other), the new VIO APC device (VIO 300 D with APC 2; ERBE Elektromedizin, Tubingen, Germany) was used (pulsed APC; 15-120 W). Pushand-Pull Enteroscopy using double-balloon technique (PPE; new 1.5 mm APC probes) was used in 11 patients (5.1%). Safety and efficacy of hp-APC were recorded after each individual treatment session. Results: The mean number of treatment sessions required using hp-APC in various indications was 1.7 (1-5). For palliative tumor ablation therapy in the esophagus, it was 2.3 (1-5). Minor complications (pain, dysphagia, irritation of the intestinal wall) were observed in 24/216 patients (11.1%), major complications (gas accumulation in the intestinal wall, perforation, stenosis) in 5 patients (2.3%). Conclusions: Hp-APC appears to be safe and effective. Due to a low number of treatment sessions required, the VIO APC device might be used as an alternative to Nd:YAG laser in tumor debulking. Using the new 1.5 mm probes for PPE, hp-APC was effective in the treatment of GI bleeding.