Clinical Application of Argon Plasma Coagulation in Gastrointestinal Endoscopy: Has the Time Come to Replace the Laser?

Abstract

Review nnnnnnnnnnnnnnnnnnnnnnnnnnnn nArgon plasma coagulation (APC) is a recently introduced treatment in digestive endoscopy. Since the first description of this technique [1], and of early endoscopic experience with it [2], it has become more and more widely used, so that the question arises of whether it should replace the laser in some of its indications, or in most of them, or even in all of them. In fact, its expected advantages are numerous and have been recently reiterated [3,4]. The main ones are the following: effective and safe coagulation; noncontact mode (2 ± 10 mm); axial, radial, and retrograde application; controllable depth of coagulation (0.5 ± 3 mm); marked desiccation; no destruction of metal stents; little smoke or vapor; mobile handy apparatus; steerable, robust, and cheap applicators; low cost in purchase, use, and maintenance and no extended safety precautions. In this review we sum up the situation regarding the published data on the main indications of APC in gastrointestinal diseases, and to compare the results in medical literature with our own experience in, up to now, more than 300 patients.The best results were expected to be found in hemorrhagic lesions. Four kinds of lesions have been treated: angiomata, watermelon stomach, radiation proctitis, and bleeding peptic ulcers. The results are summarized in Table 1, compared with those of the laser in a recent review [5]. At first sight, the clinical impression is that the efficiency of APC is equal or even superior to that of the laser, with a lower complication rate. However, it should be noted that most of the studies were published only in abstract form and results were given for all indications collectively, without results for each specific indication, so that the data in Table 1 are often extrapolations. Moreover, follow-up is often insufficient, practical details of the procedure are not given (i. e.: power setting, gas flow, frequency of sessions), and efficacy criteria (clinical, endoscopic, biological) vary from one study to another and are often not specified. In the case of digestive angiomata, the number of patients treated and the follow-up are sufficient to conclude that APC is an effective and safe method compared with laser [6 ± 10]. Although perforation is rare ± about 0.31 % according to Grund, cited by Hoyer et al. [11] it is still possible. One case has been described after treatment of cecal angiodysplasia, without need for laparotomy [12]. In various indications, other side effects have been reported, such as submucosal emphysema which is classic but mild, and inflammatory polyp which is rare and mild [12]. One bowel gas explosion has been reported, during a palliative treatment of a colonic cancer [13].With regard to treatment of radiation proctitis by APC, eight studies have been published, in which 129 patients have been treated [14 ± 21]. We published the largest one (30 patients) with the longest follow-up (mean follow-up 23 months, range 9 ± 48) [19]. Results are promising, since the effectiveness of APC se...

Rokcall score versus forrest classification in endoscopic management of bleeding peptic ulcer

“…Mortality is increasing with increasing age and is significantly higher in patients who are already admitted in hospital for co-morbidity [3]. Risk factors for peptic ulcer bleeding are non-steroid anti-inflammatory drugs (NSAIDs) use and Helicobacter Pylori (HP) infection [8].…”

“…The maximum coagulation depth achieved by APC is 3 to 4 mm, which minimizes the risk of perforation. Continuous suction was applied to remove smoke and prevent over inflation of the GIT [3].…”

“…The use of APC in digestive tract endoscopy was first described in 1994. It is being applied more and more widely in the treatment of different GI pathologic disorders, hemorrhagic lesions in particular [3]. The only mechanical therapies widely available are endoscopically placed clips and band ligation devices.…”

Adrenaline Injection Plus Argon Plasma Coagulation versus Adrenaline Injection Plus Hemoclips for Treating High-Risk Bleeding Peptic Ulcers: A Prospective, Randomized Trial

“…APC, on the other hand, is easier to target to the bleeding sites than hemoclips (26)(27)(28). Despite promising efficacy for the treatment of angiodysplasia, gastric antral vascular ectasia and radiation proctitis, there are few published trials regarding the efficacy of APC for bleeding peptic ulcers.…”

Progress in Endoscopic Treatment of Upper Gastrointestinal Bleeding

“…b) Non-contact heat coagulation hemostasis: Argon Plasma Coagulator (APC), Laser Photocoagulation and so on. APC is often applied to peptic ulcers, tumors and vascular stump hemorrhages [11]. It transmits high-frequency energy to the lesion tissue by emitting argon gas.…”