Argon plasma coagulation (APC) - Clinical usefulness in flexible endoscopy

APC is a new therapeutic modality which combines the best properties of a laser and electrocoagulation. The safety, portability, ease of use, and inexpensiveness render this modality a valuable adjunct to flexible endoscopy. Inert argon gas can be ionized when used in conjunction with an electrosurgical generator The ionized gas (plasma) forms an electrical arc which desiccates tissue. At a fixed power output setting, a reproducible depth of tissue desiccation is achieved which can be varied from .5 to 3 mm in thickness. Large numbers of patients have been treated in Europe with this modality, which is used in preference to the laser in many centers. METHODS : A pilot project of its usefulness and efficacy commenced over a 4 month period. This was the first application of APC in endoscopy in the U.S.A. Informed consent was obtained from each patient. The range of use included the following for upper GI endoscopy: Diffuse oozing from the stomach wall following sub-total gastrectomy(1) Bleeding after polypectomy(2). Arteriovenous malformation of the stomach(1). Fulguration of residual tissue after sessile polypectomy(1). GAVE(2) Use in the colon included the following: Arteriovenous malformations(5). Fulguration of a circumferential carcinoma in a non-operative patient(1). Bleeding requiring transfusion in radiotherapy proctitis(1). Ablation of residual tissue following sessile polypectomy(20). No complications were encountered Pneumatosis induced by argon gas infiltrating into the submucosal tissue during inadvertent tissue contact occurred in 2 patients during colonoscopy and 1 during gastroscopy. These produced no clinical symptoms, and resolved spontaneously. FOLLOW-UP: Bleeding and arteriovenous malformations were immediately controlled/ablated with APC. Watermelon stomach showed marked decrease in vascular ectasias. 5 patients who had APC for residual fragments of sessile polyp were reevaluated, and 4 had complete absence of residual adenoma, with one having a small ridge-like recurrence of residual adenoma. CONCLUSION: APC is safe, and techniques of application are readily learned. This modality is a major addition to flexible endoscopy.