Safety and efficacy of argon plasma coagulator ablation therapy for flat colorectal adenomas

Abstract

Introduction: argon-plasma coagulation (APC) has been used safely and efficaciously in multiple settings including colon polyp treatment. The aim of this study was to evaluate APC efficacy and safety in the treatment of flat colorectal adenomas. Materials and methods: APC ablation was prospectively performed and evaluated in 22 consecutive patients with colorectal adenomas, 11 of which had large sessile adenomas that were treated with piecemeal polypectomy and APC ablation of residual adenomatous tissue, whereas the remaining eleven patients with flat or carpet-like adenomas were only treated with APC. The mean initial longitudinal extension of adenomas to be treated with APC was 22 mm (range, 20 to 40 mm). Results: the mean age of patients was 70 years. Adenomas were found most frequently in the rectum (50%) and cecum (23%). Complete ablation was achieved in 90.9% of adenomas. Recurrence was observed in 20% of patients, all of them in the rectum, after a mean follow-up period of 16.3 months (range, 8 to 35). All recurrences were managed satisfactorily. No major complications were seen. Conclusions: argon plasma coagulator ablation of flat colorectal adenomas is an efficacious and safe technique, specially in the right colon, but results must be confirmed in controlled trials with a higher number of patients.

European guidelines for quality assurance in colorectal cancer screening and diagnosis. First Edition – Management of lesions detected in colorectal cancer screening

“…The saline injection has two main functions; firstly, elevating the lesion facilitates the placement of a snare around it, and secondly, it protects the underlying muscle from damage thereby reducing the risk of perforation. For lesions > 20 mm a similar technique may be employed but piecemeal excision is necessary [15,61], and argon plasma coagulation can be used as an adjunct to this technique in order to destroy residual adenoma tissue [5,20]. If a lesion does not lift with sub-mucosal injection, snaring should not be attempted as this indicates involvement of the underlying muscle [11].…”

Cold snare polypectomy vs. hot snare polypectomy vs. argon plasma coagulation for small (5–9mm) left-sided colorectal polyps: a prospective randomized trial

“…On the other hand, APC is an ablation technique that has been extensively used to treat visible residual neoplasia after EMR [15], but its use for the removal of colorectal polyps has not been systematically studied so far. The few studies that attempt to tackle this issue are mostly old ones, with small patient samples and weakly defined outcomes [16] or publications with significant methodological flaws or unclear presentation that preclude the extraction of well-tolerated conclusions [24]. García et al .…”

“…García et al . [16] applied APC in a small group of 22 patients, 11 of them with large sessile adenomas resected by means of piecemeal EMR and APC ablation being performed on residual adenomatous tissue, whereas in the remaining 11 patients that had flat, or carpet-like adenomas APC was the exclusive treatment. The outcome was adenoma recurrence, which was 20% overall, with only 1 recurrence in the group of patients treated exclusively by APC.…”

“…On the other hand, APC is an ablation technique that has been extensively used to treat visible residual neoplasia after EMR [15], but its use for the removal of colorectal polyps has not been systematically studied so far. The few studies that attempt to tackle this issue are mostly old ones, with small patient samples and weakly defined outcomes [16] or publications with significant methodological flaws or unclear presentation that preclude the extraction of well-tolerated conclusions [24]. García et al [16] applied APC in a small group of 22 patients, 11 of them with large sessile adenomas resected by means of piecemeal EMR and APC ablation being performed on residual adenomatous tissue, whereas in the remaining 11 patients that had flat, or carpet-like adenomas APC was the exclusive treatment.…”

Argon plasma coagulation in coloproctology: clinical experience with and prospects for the technique

“…С 1991 г. в «гибкой» эндоскопии получил распространение метод АПК, обладающий 2 важными качествами: с одной стороны, обеспечивает эффектив-ную коагуляцию обширных поверхностей, с другой -позволяет выполнять коагуляцию при хорошо регули-руемой и равномерной глубине проникновения [26]. АПК применяют для снижения частоты рецидива при фрагментарном удалении диатермической петлей аденом прямой и ободочной кишки [27][28][29][30][31][32]. В насто-ящем исследовании мы стремились дать свою оценку данному методу при удалении LST-G с низким риском подслизистой инвазии, локализованных в прямой кишке.…”