Argon plasma coagulation for prevention of recurrent bleeding from GI angiodysplasias

Olmos, Jorge; Marcolongo, Mariano; Pogorelsky, Valeria; Varela, Emilio; Dávolos, Jorge

doi:10.1016/s0016-5107(04)02221-7

Cited by 55 publications

(37 citation statements)

References 26 publications

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“…Bizim vakamızın APC yöntemiyle beraber destek tedavisine verdiği hızlı cevap APC'nin HHT'ye bağlı anjiodisplazik lezyonlarda seçkin tedavi yöntemi olduğu görüşünü desteklemektedir (22)(23)(24). Yapılan yayınları incelediğimizde HHT'li olgularda özellikle endoskopik ve farmakolojik tedavi kombinasyonun uygulandığı prospektif bir çalışmanın olmaması bu alandaki bilgilerimizi sınırlamaktadır.…”

Section: Discussionunclassified

Herediter hemorajik telenjektazili bir vakanın, argon plazma koagülasyonu ve destek tedavisi kombinasyonuyla başarılı yönetimi

Yeşıl¹,

Şenateş²,

Kayataş³

et al. 2015

Endoskopi Gastrointestinal

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Section: Discussionunclassified

Herediter hemorajik telenjektazili bir vakanın, argon plazma koagülasyonu ve destek tedavisi kombinasyonuyla başarılı yönetimi

Yeşıl¹,

Şenateş²,

Kayataş³

et al. 2015

Endoskopi Gastrointestinal

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“…11). Endoscopic treatment of bleeding secondary to diverticulosis includes epinephrine injection, contact thermal modalities, hemoclip application, band ligation, and a combination of the above [54,[61][62][63][64].…”

Section: Diverticular Bleedingmentioning

confidence: 99%

“…They are usually a few mm in size but may be as big as 1 cm or larger [66]. Endoscopic hemostasis has been successfully reported using thermal modalities (bipolar probe, heater probe, and APC) as well as injection therapy [47,63,64]. Alternatively, hemostasis can be achieved with a heater probe.…”

Section: Vascular Anomalies (Angiodysplasias Angiovascular Malformatmentioning

confidence: 99%

Therapeutic and interventional endoscopy for gastrointestinal bleeding

Jovanović

Vormbrock

et al. 2011

Eur J Trauma Emerg Surg

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mentioning

confidence: 99%

“…Argon plasma is also considered the gold standard in the treatment of angiodysplasia no matter where (18,19), hence endoscopists take it to whatever target area they may choose -the esophagus, stomach, small bowel, or colon. Regarding the right colon, in view of its thin wall, perforations associated with its use have been reported (19), thus argon plasma must be used with a lower power output setup or together with saline injections at its base to limit the extent of electrical insult to deeper layers (20,21). APC's excellent hemostatic capacity has prompted its use in order to improve results with other techniques in different scenarios, including esophageal varices after band ligation (22) and Dieulafoy lesions to prevent recurrent bleeding once primary hemostasis is achieved with 1/10,000 adrenaline injections (23).…”

mentioning

confidence: 99%

Argon plasma coagulator: "primum non nocere"

Muñoz

2009

Rev. esp. enferm. dig.

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More than 10 years ago I wondered whether argon plasma coagulation (APC) would prove revolutionary for therapeutic endoscopy (1). Now, time has settled the question. We now know that APC sources are essential in all endoscopy units around the world, but their use is basically restricted to hemostatic procedures. Ablative applications have been relegated to mere "touch-ups" to finish off other techniques, which today anew seem revolutionary.APC has also evolved, and second-generation sources are now available that provide several application modes: forced, pulsed, and precise, with various coagulation effects (2).The forced modality is characterized by continuous monopolar current, which is delivered to the target tissue through a conductive flow of ionized argon gas (argon plasma), and represents the energy dispensed by present-day sources. In pulsed mode discontinuous current is delivered to provide one of two effects: effect one with higher intensity current and longer pauses, and effect two with a higher number of lower-energy pulses. Finally, with the precise mode argon plasma may be regulated using an electronic setup regardless of system impedance and target distance, provided the latter is shorter than 5 mm (3). The effectiveness of second-generation APC is 50% higher than that of original generators (4).The primary benefit attributed to argon plasma is its capability to cause limited damage in superficial layers, since current moves from treated, dried-up areas with a higher resistance to untreated areas with a lower resistance, with this drift protecting patients from potential perforation by deep burns (5,6). In contrast, more recent studies in experimental models show significant damage to the muscularis propria with severity increasing with dispensed energy amount, pulse duration, and target area; the layer is hit by 86% of 40W shots or 69% of applications longer than 5 seconds using both traditional (7) or second-generation sources (8), the latter requiring greater caution given their increased energetic yield by nearly 50%.Obviously, continuous gas flow during delivery results in gastrointestinal tract distension and patient discomfort, an adverse effect that may be easily countered by repeat aspirations during therapy pauses.The most devastating, feared effect is no doubt a deflagration of inflammable gases within the colon. This is why patients scheduled to undergo argon plasma therapy must be fully prepared in an anterograde manner using a sugar-free solution regardless of the target area for APC. Just because actinic proctitis is the condition to be treated, as is the case with Tormo et al. (9), it does not mean that full preparation (using phosphates in our case) to prevent gases from exploding may be overlooked.Argon plasma coagulator -"primum non nocere"

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Argon plasma coagulation for prevention of recurrent bleeding from GI angiodysplasias

Cited by 55 publications

References 26 publications

Herediter hemorajik telenjektazili bir vakanın, argon plazma koagülasyonu ve destek tedavisi kombinasyonuyla başarılı yönetimi

Herediter hemorajik telenjektazili bir vakanın, argon plazma koagülasyonu ve destek tedavisi kombinasyonuyla başarılı yönetimi

Therapeutic and interventional endoscopy for gastrointestinal bleeding

Argon plasma coagulator: "primum non nocere"

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