Is argon plasma coagulation an efficient treatment for digestive vascular malformation and radiation proctitis?

Background and aims - Argon beam coagulation is an innovative no-touch elec trocoagulation technique in which high-frequency monopolar alternating curr ent is delivered to the tissue through ionized argon gas. The aim of this p rospective study was to evaluate the efficacy and safety of argon plasma co agulation (APC) for the treatment of hemorrhagic digestive vascular malform ations and hemorrhagic radiation proctosigmoiditis. Methods and patients - From March 1998 through April 1999 we used endoscopi c APC (ERBE Lyon France, argon gas source ICC 300, high-frequency electrosu rgical generator ICC 200, gas now I L/min, power setting 50 W) to treat 39 consecutive patients (mean age 70.3 +/- 10 years). The indications for trea tment were anemia (n = 10) active or oozing haemorrhage (n = In from digest ive angiodysplastic lesions (n = 25), hemorrhagic antral telangiectatic vas cular lesions (n = 2) and hemorrhagic radiation proctosigmoiditis (n = 12) after failure of medical treatments (5-aminosalicylic acid, corticosteroids , or sucralfate enemas). The efficacy of APC treatment was evaluated on sym ptoms, transfusion requirement bleeding recurrence, hemoglobin value before and 6 months after APC therapy. Results - On the average, 1 +/- 0.5 sessions per patient was required to tr eat digestive vascular malformations. Definitive haemostasis of digestive a ngiodysplastic lesions with active or oozing haemorrhage was achieved in on e session in all patients. No bleeding recurrence wets observed during the follow-up period of 6 months. Anemia recurrence was observed in 2 patients (7%). Average hemoglobin levels recorded before and 6 months after APC ther apy were 78.8 +/- 21.2 g/L and 108 +/- 13.7 g/L, respectively (P < 0.05). O n the average, 2.8 +/- 0.8 sessions per patient were required to treat hemo rrhagic radiation proctosigmoiditis. Ten patients (83%) reported improvemen t or cessation of rectal bleeding most of them 'immediately after APC thera py. Endoscopic control was performed one month after APC therapy and showed complete disappearance of lesions in 8 patients (66%). Average hemoglobin levels recorded before and 6 months after APC therapy were of 102.7 +/- 21 g/L and 120 +/- 19.5 g/L, respectively (P < 0.05). Complications were obser ved in 5 cases (13%): pneumo-peritoneum in 2 cases, chronic rectal ulcerati ons in 2 cases, and nonsymptomatic rectal stenosis in 1 case. Conclusion -APC appears to be a simple, safe, and effective technique in th e management of hemorrhagic radiation-induced proctosigmoiditis and hemorrh agic lesions.