Inflammatory Polyps: An Unreported Side Effect of Argon Plasma Coagulation

Schmeck-Lindenau, H. J.; Kurtz, W; Heine, Michael

doi:10.1055/s-2007-1001410

Cited by 11 publications

(6 citation statements)

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“…One severe case of sepsis, which conduced to death due to infectious peritonitis, has also been described [60] . The risk of intestinal perforation is very low and limited to very thin-walled structures (i.e., caecum) [58,61] ; notably, no case of perforation during APC treatment of GAVE has been described.…”

Section: Endoscopic Treatmentmentioning

confidence: 99%

Diagnosis and management of gastric antral vascular ectasia

Fuccio¹

2013

WJGE

126

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Gastric antral vascular ectasia (GAVE) is an uncommon but often severe cause of upper gastrointestinal (GI) bleeding, responsible of about 4% of non-variceal upper GI haemorrhage. The diagnosis is mainly based on endoscopic pattern and, for uncertain cases, on histology. GAVE is characterized by a pathognomonic endoscopic pattern, mainly represented by red spots either organized in stripes radially departing from pylorus, defined as watermelon stomach, or arranged in a diffused-way, the so called honeycomb stomach. The histological pattern, although not pathognomonic, is characterized by four alterations: vascular ectasia of mucosal capillaries, focal thrombosis, spindle cell proliferation and fibrohyalinosis, which consist of homogeneous substance around the ectatic capillaries of the lamina propria. The main differential diagnosis is with Portal Hypertensive Gastropathy, that can frequently co-exists, since about 30% of patients with GAVE co-present a liver cirrhosis. Autoimmune disorders, mainly represented by Reynaud's phenomenon and sclerodactyly, are co-present in about 60% of patients with GAVE; other autoimmune and connective tissue disorders are occasionally reported such as Sjogren's syndrome, systemic lupus erythematosus, primary biliary cirrhosis and systemic sclerosis. In the remaining cases, GAVE syndrome has been described in patients with chronic renal failure, bone marrow transplantation and cardiac diseases. The pathogenesis of GAVE is still obscure and many hypotheses have been proposed such as mechanical stress, humoural and autoimmune factors and hemodynamic alterations. In the last two decades, many therapeutic options have been proposed including surgical, endoscopic and medical choices. Medical therapy has not clearly shown satisfactory results and surgery should only be considered for refractory severe cases, since this approach has significant mortality and morbidity risks, especially in the setting of portal hypertension and liver cirrhosis. Endoscopic therapy, particularly treatment with Argon Plasma Coagulation, has shown to be as effective and also safer than surgery, and should be considered the first-line treatment for patients with GAVE-related bleeding.

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Section: Endoscopic Treatmentmentioning

confidence: 99%

Diagnosis and management of gastric antral vascular ectasia

Fuccio¹

2013

WJGE

126

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“…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].…”

mentioning

confidence: 99%

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

Canard¹,

Vedrenne²

2001

Endoscopy

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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...

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“…Inflammatory polyps emerged after APC application in one cecal polyp, but they disappeared spontaneously as reported in following controls. This complication had been previously described after APC in the upper gastrointestinal tract (28).…”

Section: Discussionmentioning

confidence: 56%

“…La presencia de pólipos inflamatorios sobre un área previamente tratada con AP ha sido descrita previamente a nivel del tracto digestivo superior (28). En un caso nuestro, se observó tras la aplicación del AP en ciego, y desaparecieron espontáneamente en controles posteriores.…”

Section: Discussionunclassified

Safety and efficacy of argon plasma coagulator ablation therapy for flat colorectal adenomas

García¹,

Núñez

González-Asanza

et al. 2004

Rev. esp. enferm. dig.

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Introduction: argon-plasma coagulation (APC) has been used safely and efficaciously in multiple settings including colon polyp treatment. The aim of this study was to evaluate APC efficacy and safety in the treatment of flat colorectal adenomas. Materials and methods: APC ablation was prospectively performed and evaluated in 22 consecutive patients with colorectal adenomas, 11 of which had large sessile adenomas that were treated with piecemeal polypectomy and APC ablation of residual adenomatous tissue, whereas the remaining eleven patients with flat or carpet-like adenomas were only treated with APC. The mean initial longitudinal extension of adenomas to be treated with APC was 22 mm (range, 20 to 40 mm). Results: the mean age of patients was 70 years. Adenomas were found most frequently in the rectum (50%) and cecum (23%). Complete ablation was achieved in 90.9% of adenomas. Recurrence was observed in 20% of patients, all of them in the rectum, after a mean follow-up period of 16.3 months (range, 8 to 35). All recurrences were managed satisfactorily. No major complications were seen. Conclusions: argon plasma coagulator ablation of flat colorectal adenomas is an efficacious and safe technique, specially in the right colon, but results must be confirmed in controlled trials with a higher number of patients.

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Inflammatory Polyps: An Unreported Side Effect of Argon Plasma Coagulation

Cited by 11 publications

References 0 publications

Diagnosis and management of gastric antral vascular ectasia

Diagnosis and management of gastric antral vascular ectasia

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

Safety and efficacy of argon plasma coagulator ablation therapy for flat colorectal adenomas

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