Effect of Argon Plasma Coagulation in Patients With Upper Gastrointestinal Active Hemorrhage

Abstract

Background : Acute upper gastrointestinal hemorrhage is a common and life-threatening medical emergency. Despite a large number of endoscopic methods for hemostasis, active bleeding lacks an adequate therapeutic remedy. The aim of the present study was to evaluate the hemostatic effect of argon plasma coagulation on upper gastrointestinal active bleeding, especially in comparison with heater probe and pure ethanol injection therapy. Methods : Sixty-eight patients with 77 lesions presenting active bleeding were treated endoscopically and divided into three groups depending on the procedures, that is, argon plasma coagulation group (27 patients with 32 lesions), heater probe group (20 patients with 22 lesions) and pure ethanol injection group (21 patients with 23 lesions). The three groups were similar with respect to all background variables. Episodes of rebleeding were retreated with the same modality as used previously. Results : The primary hemostatic rate in the argon plasma coagulation group was 81.3%, that in the heater probe group was 77.3%, and that in the pure ethanol injection group was 87.0%. The permanent hemostatic rate in the argon plasma coagulation group was 75.0%, that in the heater probe group was 63.6%, and that in the pure ethanol injection group was 78.3%. When examined in terms of Forrest's criteria, the argon plasma coagulation group in Forrest's type I b and the pure ethanol injection group in type I a showed the highest permanent hemostatic rate. Conclusions : Argon plasma coagulation is most suitable in arresting oozing hemorrhage. If pure ethanol injection therapy is possible, it is more effective than other therapies in the case of spurters.

Long‐term Follow Up of Gastric Antral Vascular Ectasia Treated by Argon Plasma Coagulation

“…APC allows easy control of the depth of coagulation, so it is simpler to obtain shallow tissue coagulation compared with mono‐polar electrocoagulation or laser coagulation 5–8 . APC is also reported to be useful for hemostasis of bleeding ulcers, 9–11 for angiodysplasia 12,13 and radiation enteritis, 14 for mucosal fibrosis therapy of esophageal varices, 15 and for coagulation of Barrett's epithelium 16 and malignant tumors 17,18 . APC allows rapid coagulation of a wide region, so it appears to be more useful than conventional methods for the treatment of extensive lesions with superficial oozing bleeding, such as GAVE.…”