High Power Setting Argon Plasma Coagulation for The Eradication of Barrett's Esophagus

Pereira-Lima, Júlio Carlos; Busnello, João Vicente; Saul, Carlos; Toneloto, Eunice B; Lopes, César Vivian; Rynkowski, Carla Bittencourt; Blaya, Carolina

doi:10.1111/j.1572-0241.2000.02197.x

Cited by 129 publications

(61 citation statements)

References 28 publications

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“…[5][6][7] Most commonly used ablative therapies are argon plasma coagulation and photodynamic therapy. [8][9][10][11][12][13][14][15][16][17] However, success rates of these therapies vary and complete ablation is not achieved in all patients. Further, residual BE may be present after ablation in at least one-third of the patients and may be hidden underneath the restored squamous epithelial lining.…”

mentioning

confidence: 99%

Genomic analysis of Barrett's esophagus after ablative therapy: Persistence of genetic alterations at tumor suppressor loci

Hage

Siersema

Vissers

et al. 2005

Intl Journal of Cancer

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Barrett's esophagus (BE) is a major predisposing factor for the development of esophageal adenocarcinoma. Current strategies for treatment of BE, both dysplastic and nondysplastic, include photodynamic therapy (PDT) and argon plasma coagulation (APC). However, the effect of ablative therapy at the genetic level is unclear. We performed loss of heterozygosity (LOH) analysis of BE in baseline and follow-up biopsy specimens from 21 patients with BE (17 male, 4 female) treated with PDT and/or APC. At baseline, 14 patients had intestinal metaplasia without dysplasia (MET), 4 low-grade dysplasia (LGD) and 3 high-grade dysplasia (HGD). LOH was assessed using a panel of 9 polymorphic markers for evaluation of the P53 gene on 17p, P16 on 9p, DCC and SMAD4 on 18q and the APC gene on 5q. The tissue specimens obtained at baseline (t 5 0) were analysed, as well as the first (t 5 1; mean interval: 4 months) and last (t 5 2; mean interval: 8 months) available biopsy with residual or recurrent BE after ablation. At t 5 0, allelic loss was detected of 5q in 27%, 9p in 56%, 17p in 31% and 18q in 6% of informative cases. At t 5 1 (18 patients with persistent MET and 3 with LGD) and at t 5 2 (8 MET, 2 LGD), the LOH patterns were not statistically different from t 5 0. Further, multiple genetic lineages before and after therapy were detected in 15 cases illustrating the multiclonal nature of BE. We conclude that recurrent and/or persistent BE after ablative therapy still contains genetic alterations associated with malignant progression to cancer. Therefore, the goal of treatment should be the complete elimination of Barrett's mucosa. ' 2005 Wiley-Liss, Inc.

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mentioning

confidence: 99%

Genomic analysis of Barrett's esophagus after ablative therapy: Persistence of genetic alterations at tumor suppressor loci

Hage

Siersema

Vissers

et al. 2005

Intl Journal of Cancer

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“…Pereira-Lima et al [7] , Pedrazzani et al [6] , Schulz et al [16] and Ragunath et al [17] applied higher amounts of energy of argon plasma, treating patients with Barrett's esophagus (65 to 70 W for 10 s vs 90 W for a short interval). Pereira-Lima et al [7] , Pedrazzani et al [6] and Schulz et al [16] obtained complete eradication of the metaplastic epithelium, while Ragunath et al [17] obtained 65% eradication of the metaplastic epithelium. However, complications as stenosis, pleural infusion, one case of pneumoperitoneum and one case of hemorrhage for ulcer were observed in their series.…”

Section: Discussionmentioning

confidence: 99%

“…However, reports of severe complications associated to endoscopic coagulation are common [4,5] . Pleural effusion, esophageal and colonic perforation and fistulae have followed argon plasma coagulation [6][7][8] . A case of colonic perforation has been associated to bipolar coagulation [9] .…”

Section: Introductionmentioning

confidence: 99%

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Histology assessment of bipolar coagulation and argon plasma coagulation on digestive tract

Garrido¹

2014

WJGE

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AIM:To analyze the effect of bipolar electrocoagulation and argon plasma coagulation on fresh specimens of gastrointestinal tract. METHODS:An experimental evaluation was performed at Hospital das Clinicas of the University of São Paulo, on 31 fresh surgical specimens using argon plasma coagulation and bipolar electrocoagulation at different time intervals. The depth of tissue damage was histopathologically analyzed by single senior pathologist unaware of the coagulation method and power setting applied. To analyze the results, the mucosa was divided in superficial mucosa (epithelial layer of the esophagus and superficial portion of the glandular layer of the stomach and colon) intermediate mucosa (until the lamina propria of the esophagus and until the bottom of the glandular layer of the stomach and colon) and muscularis mucosa. Necrosis involvement of the layers was compared in several combinations of power and time interval. RESULTS:Involvement of the intermediate mucosa of the stomach and of the muscularis mucosa of the three organs was more frequent when higher amounts of energy were used with argon plasma. In the esophagus and in the colon, injury of the intermediate mucosa was frequent, even when small amounts of energy were used. The use of bipolar electrocoagulation resulted in more frequent involvement of the intermediate mucosa and of the muscularis mucosa of the esophagus and of the colon when higher amounts of energy were used. In the stomach, these involvements were rare. The risk of injury of the muscularis propria was significant only in the colon when argon plasma coagulation was employed. CONCLUSION:Tissue damage after argon plasma coagulation is deeper than bipolar electrocoagulation. Both of them depend on the amount of energy used. Key words: Argon plasma coagulation; Electrocoagulation; Gastrointestinal endoscopy; Surgical procedures; Endoscopic gastrointestinal; Mucous membrane/injuries Core tip: The best way of applying heat to hollow digestive organs during thermal endoscopic therapy has not been clearly established so far. This study analyzes the histophathological effect of bipolar electrocoagulation and argon plasma coagulation on fresh surgical specimens of the digestive tract. Tissue damage after argon plasma coagulation is deeper than bipolar electrocoagulation. Both of them depends on the amount of energy used.

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“…The majority of these studies enrolled patients with Barrett's esophagus without dysplasia, while a few included patients with both low-grade dysplasia and high-grade dysplasia (Attwood et al, 2003;Pereira-Lima, et al, 2000;Ragunath et al, 2005). APC was effective in completely eradicating intestinal metaplasia in 58%-100% of cases, depending on the series.…”

Section: Argon Plasma Coagulationmentioning

confidence: 99%

Nonsurgical Management of Esophageal Cancer

Safa¹,

Reda²

2012

Esophageal Cancer - Cell and Molecular Biology, Biomarkers, Nutrition and Treatment

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High Power Setting Argon Plasma Coagulation for The Eradication of Barrett's Esophagus

Cited by 129 publications

References 28 publications

Genomic analysis of Barrett's esophagus after ablative therapy: Persistence of genetic alterations at tumor suppressor loci

Genomic analysis of Barrett's esophagus after ablative therapy: Persistence of genetic alterations at tumor suppressor loci

Histology assessment of bipolar coagulation and argon plasma coagulation on digestive tract

Nonsurgical Management of Esophageal Cancer

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