The efficacy and safety of argon plasma coagulation therapy in Barrett's esophagus

Grade, Andrew J.; Shah, Ifat A.; Medlin, Susan M.; Ramirez, Francisco C.

doi:10.1016/s0016-5107(99)70338-x

Cited by 88 publications

(20 citation statements)

References 25 publications

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“…This is particularly relevant when Barrett involves the whole circumference of the organ, increasing the risk of stenosis. Using argon plasma with 60 W potency for 1 s to destroy Barrett´s Esophagus, Grade et al [15] observed intestinal metaplasia below repaired squamous epithelium in 20% of the cases. With this amount of energy they had no complications.…”

Section: Discussionmentioning

confidence: 99%

Histology assessment of bipolar coagulation and argon plasma coagulation on digestive tract

Garrido¹

2014

WJGE

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AIM:To analyze the effect of bipolar electrocoagulation and argon plasma coagulation on fresh specimens of gastrointestinal tract. METHODS:An experimental evaluation was performed at Hospital das Clinicas of the University of São Paulo, on 31 fresh surgical specimens using argon plasma coagulation and bipolar electrocoagulation at different time intervals. The depth of tissue damage was histopathologically analyzed by single senior pathologist unaware of the coagulation method and power setting applied. To analyze the results, the mucosa was divided in superficial mucosa (epithelial layer of the esophagus and superficial portion of the glandular layer of the stomach and colon) intermediate mucosa (until the lamina propria of the esophagus and until the bottom of the glandular layer of the stomach and colon) and muscularis mucosa. Necrosis involvement of the layers was compared in several combinations of power and time interval. RESULTS:Involvement of the intermediate mucosa of the stomach and of the muscularis mucosa of the three organs was more frequent when higher amounts of energy were used with argon plasma. In the esophagus and in the colon, injury of the intermediate mucosa was frequent, even when small amounts of energy were used. The use of bipolar electrocoagulation resulted in more frequent involvement of the intermediate mucosa and of the muscularis mucosa of the esophagus and of the colon when higher amounts of energy were used. In the stomach, these involvements were rare. The risk of injury of the muscularis propria was significant only in the colon when argon plasma coagulation was employed. CONCLUSION:Tissue damage after argon plasma coagulation is deeper than bipolar electrocoagulation. Both of them depend on the amount of energy used. Key words: Argon plasma coagulation; Electrocoagulation; Gastrointestinal endoscopy; Surgical procedures; Endoscopic gastrointestinal; Mucous membrane/injuries Core tip: The best way of applying heat to hollow digestive organs during thermal endoscopic therapy has not been clearly established so far. This study analyzes the histophathological effect of bipolar electrocoagulation and argon plasma coagulation on fresh surgical specimens of the digestive tract. Tissue damage after argon plasma coagulation is deeper than bipolar electrocoagulation. Both of them depends on the amount of energy used.

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Section: Discussionmentioning

confidence: 99%

Histology assessment of bipolar coagulation and argon plasma coagulation on digestive tract

Garrido¹

2014

WJGE

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“…In the series of Martin et al [34], 20 of 26 patients had endoscopic remission; however, 9 had residual subsquamous intestinal metaplasia. In the 9 patients reported on by Grade et al [35], all had full-circumference BE segments, of which one half was treated. In the treated area, all 9 patients had squamous reepithelialization, but 2 patients had subsquamous intestinal metaplasia.…”

Section: Ablation Plus Acid Suppression In Barrett's Epitheliummentioning

confidence: 94%

“…In three other series [34][35][36], Martin et al [34] reported on 26 patients treated with ABPC and PPIs; Grade et al [35] reported on 9 patients treated with ABPC and lansoprazole; and Bonavina et al [36] reported on 18 patients treated with YAG laser and omeprazole. In the series of Martin et al [34], 20 of 26 patients had endoscopic remission; however, 9 had residual subsquamous intestinal metaplasia.…”

Section: Ablation Plus Acid Suppression In Barrett's Epitheliummentioning

confidence: 99%

Acid Suppression and Reepithelialization after Ablation of Barrett’s Esophagus

Overholt

2000

Dig Dis

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The role of acid reflux in the development of esophageal columnar epithelium was first described in the early 1970s in the canine esophageal reflux model. In the presence of acid reflux, columnar epithelium developed at the site of induced esophageal mucosal injury. When reflux was suppressed, most epithelium reverted back to squamous mucosa. Similar findings in human patients with Barrett’s esophagus (BE) who were treated with laser ablation were first described in 1993. While acid suppression with antireflux surgery or proton pump inhibitors (PPIs) has proven insufficient to completely reverse BE, ablation of the lesion followed by acid suppression may be a promising option. Although at least one report disputes the importance of complete acid suppression following mucosal ablation of BE, most investigators use full-dose PPI therapy following ablation, in the belief that full acid suppression provides an environment that allows the esophageal progenitor cell to develop squamous mucosa. This article provides a review of the literature to date regarding ablative therapies and acid suppression for patients with BE.

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“…APC was performed with a high-frequency generator (APC300, ICC200; ERBE Elektromedizin GmbH, Tübingen, Germany), a flexible 1.5-mm-diameter axial probe for the transnasal endoscope and a 2.2-mm-diameter axial probe for the peroral endoscope. As described in previous reports [1,2,13,14,15], peroral APC was set with an argon gas flow rate of 1.8 liters/min and an arc output of 60 W. In contrast, the maximum power of the 1.5-mm-diameter axial probe for transnasal APC had the following limitations: a flow rate of 0.5 liters/min and an arc output of 40 W.…”

Section: Methodsmentioning

confidence: 99%

Usefulness of Transnasal Argon Plasma Coagulation for Esophageal Varices Compared with the Peroral Method: A Randomized and Prospective Clinical Study

Furuichi

Kawai²,

Ichimura³

et al. 2013

Digestion

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Background: Argon plasma coagulation (APC) is very useful as a consolidation treatment for reducing the recurrence of esophageal varices (EVs). However, repeated sedation in endoscopic treatment has the risk of prolonging hepatic encephalopathy and affects the respiratory state of liver cirrhosis (LC) patients, in whom pulmonary arteriovenous shunts are observed. We evaluated prospectively whether transnasal endoscopic APC without sedation is more effective than peroral endoscopic APC with sedation. Patients and Methods: LC patients (n = 101), treated by endoscopic injection sclerotherapy to eradicate EVs, were randomly divided into a transnasal APC group (n = 50) and a peroral APC group (n = 51). The primary efficacy endpoint was the cumulative recurrence rate of EVs. The secondary endpoints were blood pressure (BP), heart rate, oxygen saturation during APC and complications. Results: There was no significant difference in the cumulative recurrence rate of EVs at 36 months between the transnasal APC and peroral APC groups (35.0 vs. 40.8%, p = 0.39, log-rank test), indicating that transnasal APC is not inferior to peroral APC. The transnasal APC group showed more stable intraoperative BP and oxygen saturation values, and a lower incidence of epigastralgia (56.0 vs. 74.5%, p = 0.04). Conclusion: The efficacy of reducing the recurrence of EVs in the transnasal APC group was not significantly different from that in the peroral APC group. Transnasal APC caused less distress and required no sedation. Therefore, this method was more advantageous for LC patients at risk of suffering from prolongation of hepatic encephalopathy.

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The efficacy and safety of argon plasma coagulation therapy in Barrett's esophagus

Cited by 88 publications

References 25 publications

Histology assessment of bipolar coagulation and argon plasma coagulation on digestive tract

Histology assessment of bipolar coagulation and argon plasma coagulation on digestive tract

Acid Suppression and Reepithelialization after Ablation of Barrett’s Esophagus

Usefulness of Transnasal Argon Plasma Coagulation for Esophageal Varices Compared with the Peroral Method: A Randomized and Prospective Clinical Study

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