Submucosal Injection of Normal Saline can Prevent Unexpected Deep Thermal Injury of Argon Plasma Coagulation in thein vivoPorcine Stomach

Gastric intramural hematoma caused by argon plasma coagulation: treated with endoscopic incision and drainage (with videos)

“…[2][3][4] Although saline solution injection was used before APC to prevent deeper tissue injury, it is likely that an arterial vessel in the deep submucosa was damaged during APC. [2][3][4] Although saline solution injection was used before APC to prevent deeper tissue injury, it is likely that an arterial vessel in the deep submucosa was damaged during APC.…”

Evaluation of the in vivo effect of argon plasma coagulation with prior submucosal injection (Hybrid APC) in the esophagus of pigs

“…However, the pig sacrificed 1 week after APC had a deep ulcer extending to the deeper muscle layer. 17 Regarding the safety of APC, it has been reported that the incidence of perforations and strictures was less than 1%. [18][19][20][21][22][23][24] However, unexpected deep ulcers or stenosis after APC at follow-up endoscopic examination have been reported.…”

Endoscopic Treatment of Gastric Adenoma with Argon Plasma Coagulation

“…Exposure of tissue d i r e c t l y t o h i g h t e m p e r a t u r e s c a u s e s a n inflammatory response, coagulation necrosis, followed by desquamative necrosis. Immediately after exposure to thermal injury, histologic examinations of tissue specimens appeared normal, but necrosis occurred secondarily after formation of a nonvital layer (Fujishiro, 2006;Fujishiro, 2008). The electrical resistance of resected specimens is basically similar to that of the gastric mucosa in vivo.…”

“…However, Kitamura et al (Kitamura, 2006) reported one case of perforation in 40 patients whose early gastric cancers were treated with APC. Fujishiro et al (Fujishiro, 2006;Fujishiro, 2008) investigated thermal tissue damage on the stomach of living minipigs to confirm the safety of APC, including a follow-up case. A minipig was sacrificed without delay after APC application, and a stomach specimen revealed that tissue damage was limited to the shallower submucosal layer regardless of the applied time ( Fig.…”

“…Clinical experiences with endoscopic evaluation also supported the rarity of perforation and safety of APC treatment. However, there is still the possibility of the severe complication of perforation caused by APC as published in some reports (Yoshida, 2005;Fujishiro, 2008). And some studies indicated that APC-induced tissue damage could be extended to the proper muscle layer, which might lead to stricture or deformity of the gastrointestinal tract and also functional disturbance of the sphincter and peristaltic movement.…”