Hybrid Argon Plasma Coagulation for Treatment of Gastric Intestinal Metaplasia

Abstract

Hybrid argon plasma coagulation (HybridAPC® [HAPC]) is an evolution of the standard argon plasma coagulation (APC) technology, where the application of APC is preceded by highpressure needleless submucosal injection. APC is indicated for the ablation of benign and dysplastic mucosal lesions, such as vascular malformations or Barrett's mucosa. HAPC offers safety and efficacy advantages over standard APC because the submucosal injection acts as a heat sink that disperses energy. This ensures that the underlying muscularis propria remains unaffected, and only the mucosal layer is coagulated in its entirety. An 81-year-old Hispanic male was found to have a 1.2-cm mucosal nodule along the incisura of the stomach. Pathology of the biopsy specimen revealed high-grade dysplasia, and he subsequently underwent endoscopic ultrasound examination, which confirmed the presence of an isolated gastric nodule with no deep invasion of the muscularis propria, consistent with a uT1N0Mx endosonographic staging. He then underwent endoscopic submucosal dissection of the lesion. Pathology of the excised specimen confirmed the presence of multifocal high-grade dysplasia, arising in the background of extensive intestinal metaplasia. The deep margin was clear; however, the lateral resection margins showed focal involvement of intestinal metaplasia with low-grade dysplasia. Surveillance endoscopy confirmed the persistence of diffuse intestinal metaplasia. He was then treated with widespread HAPC due to the presence of underlying diffuse intestinal metaplasia in the stomach. HAPC is an effective and efficient treatment modality for mucosal lesions. In one series of 50 patients, 96% achieved complete macroscopic remission of Barrett's mucosa after a median of 3.5 APC sessions, and 85% achieved complete histological remission. HAPC is a promising therapeutic modality as a thermal injury is targeted, and the depth of injury is contained. This provides immediate procedural efficacy and safety benefits, and reduces subsequent complications when compared with standard APC. We anticipate that the applications of HAPC will continue to grow, as this modality is adopted into common procedural parlance. This case appears to be the first to describe the use of HAPC for definitive treatment of diffuse intestinal metaplasia.

Short Telomere Lesions with Dysplastic Metaplasia Histology May Represent Precancerous Lesions of Helicobacter pylori-Positive Gastric Mucosa

“…In the 2019 edition of the WHO classification of tumors of the digestive system [ 36 ], gastric dysplasia is divided into low-grade and high-grade, and the histologic subtypes are divided into intestinal, foveolar, crypt, tubule neck, and serrated. In our histological analyses, our DM cases resembled intestinal dysplasia [ 37 ], but differed in the absence of nuclear elongation. In our review, adenomas and adenomatous ducts were not included among the DM cases.…”

Endoscopic mucosal ablation - an alternative treatment for colonic polyps: Three case reports

“…Kothari et al [ 2 ] successfully treated a flat dysplastic lesion at the GJ anastomosis of a patient with a previous Roux-en-Y gastric bypass[ 2 ]. Estifan et al [ 3 ] also obtained adequate results using EMA to treat lesion recurrence after an ESD for intestinal metaplasia in the incisura[ 3 ]. The only available report of the application of this technique in the colon was published by Tsiamoulos et al [ 4 ].…”

Is endoscopic mucosal ablation a valid option for treating colon polyps?

“…We want to know the indications for the endoscopic mucosal ablation (EMA) method, such as the size of the lesion and the type of preoperative pathology. Argon plasma coagulation is often used for benign diseases or small polyps or as a supplement when there is residual tumor or recurrence after endoscopic mucosal resection[ 2 - 5 ] or endoscopic submucosal dissection[ 6 , 7 ]. For large lesions of the colon, especially laterally spreading tumors, lesions often become high-grade intraepithelial neoplasias or even cancers[ 8 ].…”