ARGON PLASMA COAGULATION IN FLEXIBLE GASTROINTESTINAL ENDOSCOPY - PILOT EXPERIENCES

Background and Study Aims: In argon plasma coagulation (APC), high-fre quency energy is transmitted to tissue by ionized gas, thus reducing c ontact with the tissue to a minimum. Successful endoscopic APC was ini tially reported in the palliative treatment of gastrointestinal neopla sms. The main objectives in this pilot study were to evaluate the trea tment indications, efficacy and safety of the use of APC. Patients and Methods: Between September 1994 and January 1996, APC was used to tre at 125 patients with various forms of gastrointestinal pathology. Resu lts: For local palliative treatment, APC was successfully used alongsi de snare loop coagulation, dilation, stenting and/or radiotherapy to t reat the following conditions: carcinoma of the esophagus: 15 patients , mean number of treatment sessions (MTS) 3.3; gastric carcinoma: 10 p atients, MTS 4.9; rectosigmoid carcinoma: seven patients, MTS 2.7; car cinoma of the papilla of Vater: two patients, MTS 1.5. Repeated treatm ent was also effective for tubulovillous adenoma of the rectum (20 pat ients, MTS 2.5), stomach (three patients, MTS 2.0), duodenum (two pati ents, MTS 1.5) and papilla of Vater (two patients, MTS 3.0). In additi on, APC proved helpful in coagulating the remaining tissue and achievi ng hemostasis after polypectomy in the colon (18 patients, MTS 1.2) an d in endoscopic treatment of Zenker's diverticulum, for coagulation of the tissue bridge and hemostasis (31 patients, MTS 2.5). Finally, APC was helpful in coagulation of multiple gastric polyps (one patient, o ne session), hemostasis in superficial ulceration of the duodenal bulb (one patient, one session), after dilation of benign stenoses of anas tomoses in the esophagus (one patient, one session) and colon (one pat ient, one session) and for vascular malformations in the colon (three patients, MTS 1.3), duodenum (one patient, one session), antrum (one p atient, two sessions), and watermelon stomach (six patients, MTS 2.8). We recognized signs of perforation in six patients after treatment of Zenker's diverticulum (n=3), polypectomy in the colon (n=2) and coagu lation of angiodysplasia in the cecum. Laparotomy was carried out in t wo patients; in one, a perforation was sutured, and in the other no fo cus of leakage was seen. All six patients recovered without further co mplications. No complications were observed in any other patients. Con clusions: These initial experiences indicate that APC seems to be effe ctive in a number of indications, and relatively safe. Objective evalu ation, a longer follow-up period, and comparative trials with other tr eatment modalities should follow.