Endobronchial argon plasma coagulation for treatment of hemoptysis and neoplastic airway obstruction

Study objective: To evaluate the usefulness of endobronchial argon plasma c oagulation (APC) for the treatment of hemoptysis and neoplastic airway obst ruction. Design: Retrospective study. Setting: Bronchoscopy unit of a university hospital. Patients: A total of 60 patients with bronchogenic carcinoma (n = 43), meta static tumors affecting the bronchi (n = 14), or benign bronchial disease ( n = 3). Indications for intervention were hemoptysis (n = 31), symptomatic airway obstruction (n = 14), and both obstruction and hemoptysis (n = 25), Hemoptysis was stratified as a volume of > 200 mL/d (n = 6), > 50 to 200 mL /d (n = 23), or 150 mL/d but persistence for > 1 week (n = 27). The mean (/- SD) duration of hemoptysis was 16.5 +/- 16.1 days before intervention. O bstruction sites were the trachea (n = 8), mainstem bronchi (n = 21), and l obar bronchi (n = 30), In 24 cases, the patient had obstructions at multipl e sites. The mean size of the pretreatment obstruction was 76 +/- 24.9%, Interventions: APC, a noncontact form of electrocoagulation, was performed via flexible bronchoscopy. Sixty patients underwent 70 procedures. Consciou s sedation without endotracheal intubation was used in all patients except four, who were mechanically ventilated because of underlying respiratory fa ilure. Measurements and results: All patients with hemoptysis experienced a resolu tion of bleeding immediately after APC. Hemoptysis from treated sires did n ot recur during a mean follow-up duration of 97 +/- 91.9 days. Patients wit h endoluminal airway lesions had an overall decrease in mean obstruction si ze to 18.3 +/- 22.1%. All patients with obstructive lesions, except one who died of sepsis, experienced symptom improvement. In these patients, sympto m control was maintained during a median follow-up period of 53 days (range , 18 to 321 days). There were no complications related to the procedure. Conclusions: APC is effective for the treatment of endoluminal hemoptysis a nd airway obstruction, The procedure can be performed in an outpatient sett ing or at the bedside in the ICUs. APC provides a simpler, lower-risk alter native to other interventional endobronchial techniques.