Evaluation of argon plasma coagulation in healing of a solitary rectal ulcer in comparison with conventional therapy: a randomised controlled trial

Abstract

IntroductionArgon plasma coagulation (APC) has been reported to be effective in the treatment of solitary rectal ulcer syndrome (SRUS). However, it has not appeared to be effective in healing ulcers.AimThis study aimed at assessing the effectiveness of APC in controlling rectal ulcer-induced bleeding, and at examining the ultimate effect of this approach in healing these lesions.Material and methodsThis randomised, controlled trial was conducted on 99 patients with SRUS. Patients were randomly enrolled into two groups of APC therapy (intervention) and conventional therapy (control). The control group (n = 58) received a high-fibre diet, laxatives, behaviour therapy, and sucralfate enemas, and the intervention group (n = 41) were treated with APC plus conventional therapy; in fact they received directed and focused argon gas in addition to a high-fibre diet and laxatives.ResultsResponses to treatment in the control group and in the APC-receiving group were 29.3% and 75.6%, respectively. The continuation of ulcer healing after 3 months in the control group was 10.3%, and it was 70.7% in the APC-treated group. There was a significant statistical difference between the two groups (p < 0.004), i.e. bleeding was controlled more frequently in the group receiving APC plus conventional therapies than in the group receiving only the conventional therapies. However, the results showed no statistically significant difference between the two groups in terms of pain relief (p < 0.36).ConclusionsArgon plasma coagulation not only controlled bleeding in patients with SRUS, but also, in comparison with the conventional methods of treating SRUS, led to healing and continuation of healing of rectal ulcers.

Evaluation of the J-Plasma Electrosurgical Device Combined with Nebulized Collagen for Burn Healing in Rodents

“…A large number of argon plasma coagulation (APC) devices are widely approved for medical and surgical use, 8 but in general, these are not considered viable for use in plasma medicine due to the production of high-temperature plasma discharges. Despite this, reports show that APC treatments are used successfully for treating ulcers 9,10 and chronic radiation proctitis. 11 However, there is limited scope for applying APC to treatment of other wounds, because thermal damage from the plasma is such that these tools have been judged as unsuitable for most wound-healing applications.…”

Endoscopic Mucosectomy: A Novel Technique for Management of Polypoidal Solitary Rectal Ulcer Syndrome

“… 8 Endoscopic APC is a promising technique for control of bleeding, but inconsistent in results. 10 , 11 In a study, responses to treatment in the control group and in the APC-treated group were 29.3% and 75.6%, respectively. The ulcer healing in the control group and APC-treated group were 10% and 70%, respectively.…”

“…The bleeding was controlled more frequently in the APC-treated group compared with the conventional therapies group ( P < .004). 10 …”

The Long-term Efficacy of Endoscopic Submucosal Dissection in the Treatment of Symptomatic Mucosal Prolapse Syndrome

“…Topical therapy and surgery are considered when conservative treatment fails. Topical therapies, such as argon plasma coagulation (APC) and neodymium yttrium-aluminum-garnet laser (Nd: YAG), cause degen-eration of the surface layer of MPS lesions directly and heal the ulcers by re-epithelialization, which leads to an improvement in the symptoms of 70-100% of the patients (13)(14)(15). Although conservative and topical treatments lead to significant improvements, the MPS lesion may persist.…”

“…Surgery improved MPS and SRUS in 77% (54-100%) of the patients; of these, 52% (25-100%) experienced recurrence (11). The long-term efficacy of topical therapy is unknown (13)(14)(15)(16)(17)(18)(19). Therefore, further research is required to determine whether or not ESD is indeed more effective than other treatments for supporting long-term remission.…”