Effectiveness of argon plasma coagulation in the treatment of chronic actinic proctitis

Tormo, V; Wikman-Jorgensen, Philip; Castillo, G García del; Ruiz, Francisco Ivorra; Egea, Alex

doi:10.4321/s1130-01082009000200002

Cited by 6 publications

(4 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Higher comorbidity is often associated with a greater severity of disease, which places these individuals at a higher risk of hospitalization and readmission [12]. Furthermore, studies have shown that RP patients may require multiple sessions of endoscopic therapy (ranging between 1 and 8) to adequately treat the clinical symptoms of RP [13][14][15][16][17]. However, no study has truly assessed the impact of lower endoscopy in reducing the readmission burden of RP.…”

Section: Discussionmentioning

confidence: 99%

Early and Late Readmissions of Radiation Proctitis in the United States: Are We Getting Better?

Dahiya,

Pinnam,

Ishaya

et al. 2024

JCM

View full text Add to dashboard Cite

Background/Aims: Radiation proctitis (RP), a well-known complication of pelvic radiation therapy, may lead to recurrent hospitalizations. We aimed to assess readmissions of RP in the United States. Methods: We analyzed the Nationwide Readmission Database from 2016 to 2020 to identify all 30-, 60-, and 90-day readmissions of RP in the United States. Hospitalization characteristics, predictors, clinical outcomes, and healthcare burdens were assessed. Results: From 2016 to 2020, we noted a declining trend of 30-, 60-, and 90-day readmissions of RP in the US. However, the all-cause 30-, 60-, and 90-day readmission rates of RP were still high at 13.7%, 19.4%, and 23.16%, respectively. On readmission, RP was identified as the admitting diagnosis in only 20.61%, 17.87%, and 15.76% of 30-, 60-, and 90-day readmissions, respectively. The mean age for all readmissions was 70 years with a significant male dominance. Lower endoscopy at index admission reduced the risk of readmissions within 90 days, but this was not statistically significant. However, the Charlson Comorbidity Index (CCI) score was an independent predictor of all readmissions. Furthermore, the mean length of stay was 5.57 (95% CI 5.15–6), 5.50 (95% CI 5.12–5.89), and 5.47 (95% CI 5.07–5.87) days and the mean hospitalization charge was USD 60,451 (95% CI USD 54,728–66,174), USD 62,671 (95% CI USD 57,326–68,015), and USD 62,144 (95% CI USD 57,144–67,144) for 30-, 60-, and 90-day readmissions. The all-cause inpatient mortality for 30-, 60-, and 90-day readmissions was 3.58%, 3.89%, and 3.46%, respectively. Conclusions: RP readmissions are a significant healthcare burden. Further efforts must be directed toward improving management strategies to reduce readmission rates.

show abstract

Section: Discussionmentioning

confidence: 99%

Early and Late Readmissions of Radiation Proctitis in the United States: Are We Getting Better?

Dahiya,

Pinnam,

Ishaya

et al. 2024

JCM

View full text Add to dashboard Cite

show abstract

“…83 The use of APC is inexpensive (in comparison to other laser therapies), it is easy to apply, and effective for the treatment of patients with radiation-induced proctopathy and bleeding. [84][85][86][87] There is no additional benefit from the use of associated oral sucralfate. 88 The use of anticoagulants and aspirin seems to be a risk factor for rebleeding.…”

Section: Argon Plasma Coagulationmentioning

confidence: 99%

Therapeutics in Radiation-induced Proctopathy: A Systematic Review

Omer

Araújo

Cruz³

et al. 2022

Journal of Coloproctology

View full text Add to dashboard Cite

Malignant neoplasms are increasingly prevalent in the daily clinical practice. Up to 61% of patients with pelvic malignancies undergo pelvic radiotherapy in different doses, which may cause intestinal damage, and the rectum is the segment most frequently affected due to its fixed position in the pelvis. Currently, there are several strategies to minimize the effects of radiation on the tissues surrounding the neoplastic site; despite those strategies, radiotherapy can still result in serious damage to organs and structures, and these injuries accompany patients throughout their lives. One of the most common damages resulting from pelvic radiotherapy is acute proctitis.The diagnosis is confirmed by visualizing the rectal mucosa through rigid or flexible rectosigmoidoscopy and colonoscopy. The objective of the present study was to review the forms of radiation-induced proctopathytherapy, and to evaluate the results of each method to propose a standardization for the treatment of this pathology. Despite the prevalence of radiation-induced proctopathy, there is no definitive standardized treatment strategy so far. The first approach can be tried with local agents, such as mesalazine and formalin. For refractory cases, control can usually be achieved with argon plasma coagulation, hyperbaric oxygen, and radiofrequency ablation therapies. Regarding the study of radiation-induced proctopathy, there is a lack of robust studies with large samples and standardized therapies to be compared. There is a lack of double-blinded, randomized controlled studies to determine a definitive standard treatment algorithm.

show abstract

“…In this indication APC has a complication rate of up to 26% in review papers (25) with slowly-healing deep ulcerations and prolonged rectal pain being most common, since radiation proctitis is basically an ischemic condition and epithelial damage should be avoided by focusing endoscopic management on the destruction of bleeding vessels using isolated, short (< 1 sec) electrofulguration pulses, making any efforts to avoid coalescence (24), and delivering low-power current (40 W) (29) except for active bleeding sites, where power may be set up to 60 W. Stringent compliance with these guidelines results in outcomes as good as those reported by Tormo et al (9). While a satisfactory response is possible, the rate of potential refractoriness to argon electrofulguration is higher in more severe proctitis with telangiectasia occupying more than 50% of the rectal mucosa, more bleeding, and therefore higher transfusional requirements.…”

mentioning

confidence: 93%

“…It is moderate proctitis, as in the study by Tormo (9), that will substantially improve clinically after APC -transfusion requirements and anemia decrease after 2-3 sessions (26)(27)(28), and bleeding subsides in the long-term in more than 80% of subjects. In this indication APC has a complication rate of up to 26% in review papers (25) with slowly-healing deep ulcerations and prolonged rectal pain being most common, since radiation proctitis is basically an ischemic condition and epithelial damage should be avoided by focusing endoscopic management on the destruction of bleeding vessels using isolated, short (< 1 sec) electrofulguration pulses, making any efforts to avoid coalescence (24), and delivering low-power current (40 W) (29) except for active bleeding sites, where power may be set up to 60 W. Stringent compliance with these guidelines results in outcomes as good as those reported by Tormo et al (9).…”

mentioning

confidence: 99%

Argon plasma coagulator: "primum non nocere"

Muñoz

2009

Rev. esp. enferm. dig.

View full text Add to dashboard Cite

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"

show abstract

Effectiveness of argon plasma coagulation in the treatment of chronic actinic proctitis

Cited by 6 publications

References 13 publications

Early and Late Readmissions of Radiation Proctitis in the United States: Are We Getting Better?

Early and Late Readmissions of Radiation Proctitis in the United States: Are We Getting Better?

Therapeutics in Radiation-induced Proctopathy: A Systematic Review

Argon plasma coagulator: "primum non nocere"

Contact Info

Product

Resources

About