药物注射联合氩离子凝固对消化性溃疡出血的疗效分析

目的 比较内镜下药物注射联合氩离子凝固治疗及单一治疗对上消化道溃疡出血的疗效.方法 将303例内镜下有活动出血的溃疡患者分为3组.157例接受内镜下药物注射止血治疗,51例接受氩离子凝固止血治疗,95例接受药物注射联合氩离子凝固治疗.结果 三种方法的即时止血率均为100%,有效止血率在药物注射组、氩离子及联合治疗组分别为为87.9%、86.3%、91.6%,三组比较无统计学差异(P>0.05).所有病例无穿孔及其它术后并发症.结论 药物注射联合氩离子凝同治疗为安全有效的止血方法,但并没有显著提高止血率.     

Long-term outcome of argon plasma coagulation therapy for bleeding caused by chronic radiation proctopathy

BACKGROUND: Radiation-induced proctopathy is a serious complication of radiation therapy for pelvic malignancy. AIM: To assess the safety and efficacy of argon plasma coagulation in the treatment of haemorrhagic radiation-induced proctopathy. PATIENTS: Twenty-four patients with rectal bleeding due to radiation-induced proctopathy were prospectively enrolled in the study. METHODS: Indications for treatment were iron deficiency anaemia (n = 16) and persistent bleeding, despite pharmacotherapy (n = 8). Argon flow and power used were 0.8-1.2 l/min and 40 W, respectively. An interval of at least 4 weeks was allowed between treatment sessions. Haemoglobin level, bleeding severity score, number of admissions and transfusion requirements were recorded after endoscopic coagulation and before 12 and 24 months. RESULTS: A median of 2.5 therapeutic sessions per patient were performed (range 1-6). All patients reported clinical improvement and/or cessation of rectal bleeding. The mean value of the bleeding severity score decreased from 2.9 to 0.8 (P < 0.01), while average haemoglobin levels increased by a mean of 1.9 mg/dl at the end of the treatments (P < 0.05). During a minimum follow-up of 24 months (range 24-60), rectal bleeding recurred in two cases and was successfully retreated endoscopically. One patient developed a recto-vaginal fistula. CONCLUSIONS: Argon plasma coagulation appears to be a safe and effective technique for management of rectal bleeding caused by radiation-induced proctopathy.     

经支气管镜氩气刀治疗气道狭窄临床观察

目的 探讨经支气管镜氩气刀治疗在气道狭窄的作用及安全性评价.方法 对140 例确诊为中心气道狭窄的患者,在积极治疗原发病的同时,经支气管镜引导进行氩离子凝固术APC.根据狭窄再通和气促评分情况评价疗效.结果 经支气管镜介入治疗1 个月后评价疗效.完全有效62 例(44.3%),部分有效55例(39.3 %),轻度有效2...     

Endoscopic resection with polypectomy snare and argon plasma coagulation in early gastric adenocarcinoma in a patient at high surgical risk

We report a patient at high surgical risk with an early gastric adenocarcinoma. Due to the size of the tumor, endoscopic mucosal resection alone was not feasible and consequently a combination of endoscopic resection with polypectomy snare and argon plasma coagulation was applied. Four years later the patient remains asymptomatic.     

Endoscopic therapy for Zenkers's diverticulum by means of argon plasma coagulation

We describe a 80-year-old man who presented with progressive dysphagia because of a Zenker's diverticulum. Barium swallow study revealed a large posterior diverticulum with a distal stenosis of the esophagus caused by compression. Because the patient was a poor candidate for surgery an endoscopic therapy was performed. The Zenker bridge was divided by argon plasma coagulation in two sessions without any complication to allow an overflow. The patient remained asymptomatic to date for a follow-up of 6 months.     

Second-generation argon plasma coagulation: two-center experience with 600 patients

Background and Aim:  Second-generation argon plasma coagulation (APC; APC 2/VIO APC) with its modes 'forced', 'pulsed', and 'precise' is a further development of the ICC/APC 300 system (first-generation APC). Until now, only limited data has existed on the use of APC 2.
Methods:  Fundamental data on the characteristics of the various APC 2 modes and clinical data from more than 600 patients treated in two high-volume endoscopy centers were analyzed. On the basis of these data, recommendations for the use of APC in daily gastroenterological practice were made.
Results:  In comparison to the ICC system, second-generation APC offers a broadened bandwidth of settings including different APC modes and a range of power settings from 1 to 120 W. Using the various modes of APC 2 in a variety of gastrointestinal diseases, minor complications were observed in 9–21% of patients. Major complications occurred in 1–7% of patients.
Conclusions:  In a two-center experience treating a large group of patients with a wide variety of gastrointestinal conditions, the different APC 2 modes appeared to be safe and effective. Certain preventive measures before and during clinical application are recommended in order to avoid complications.     

氩离子凝固术联合中药治疗上消化道出血的临床研究

[目的]探讨内镜下氩离子凝固术（APC）联合自拟止血一号方治疗非静脉曲张性上消化道出血的临床疗效。[方法]对120例确诊为非静脉曲张性上消化道出血患者,在内镜下行APC止血,予以质子泵抑制剂、静脉补液等常规治疗后,随机分为2组：治疗组（60例）,在常规治疗的基础上加用自拟止血一号方煎剂口服;对照组（60例）仅予常规治疗。比较2组治疗总有效率及再出血率、死亡率、输血量、平均住院日、住院费用等指标。[结果]治疗组和对照组的总有效率分别为96．61％和88．33％（P〈0.05）;再出血率为3．33％和11．67％（P〈0.05）;死亡率为1．67％和5．00％（P〈0.05）;输血量为（2．34±2．05）U和（4．35±3．45）U（P〈0．05）;平均住院日为（10．59±4．88）d和（15．79±8．00）d（P〈0．05）;住院费用为（8．16±1．43）千元和（13．35±1．91）千元（P〈0．05）。[结论]APC联合中药治疗上消化道出血是一种疗效显著、死亡率及输血量低、住院天数短、经济实惠的治疗方法。     

Large sessile colonic adenomas: use of argon plasma coagulator to supplement piecemeal snare polypectomy

BACKGROUND: Residual adenoma is frequently found at the site of endoscopically resected large sessile adenomas on follow-up examination. We evaluated the efficacy of a thermal energy source, the argon plasma coagulator, to destroy visible residual adenoma after piecemeal resection of sessile polyps. METHODS: Seventy-seven piecemeal polypectomies with or without the use of argon plasma coagulator were analyzed retrospectively. All polyps were sessile, 20 mm or greater in size. The results from three groups of patients were compared. The study group was composed of patients who had visible residual adenoma after piecemeal polypectomy and had the base of the polypectomy site treated with the argon plasma coagulator. The first comparison group consisted of patients who underwent standard piecemeal polypectomy in whom the colonoscopist thought that all adenomatous tissue was removed and no further treatment was necessary. The second comparison group included patients in whom visible residual adenoma was left at the base after piecemeal resection of large adenomas. Follow-up colonoscopy was performed approximately 6 months after the initial procedure to check for recurrent/residual adenomatous tissue. RESULTS: The argon plasma coagulator was used after 30 piecemeal polypectomies in an attempt to eradicate visible residual adenomatous tissue; at follow-up, 50% of these cases had complete eradication of adenoma. The group in whom all visible tumor was removed by piecemeal polypectomy alone had an adenoma eradication rate of 54% on follow-up colonoscopy. In the patients in whom visible residual adenoma was left at the site the recurrence rate was 100% on the follow-up examination. Bleeding necessitating endoscopic therapy occurred once (3.3%) in the argon plasma coagulator group; there were four (12.5%) bleeding episodes and one (3.1%) confined retroperitoneal perforation in the complete piecemeal polypectomy group and no complications in the group in which polypectomy was incomplete. CONCLUSIONS: Argon plasma coagulator ablation of residual adenomatous tissue at the polypectomy base is safe and useful. It helps to complete the eradication of large sessile polyps when there is visible evidence of residual polyp.     

Gas embolism following bronchoscopic argon plasma coagulation: a case series

Thermal ablation using argon plasma coagulation (APC) is a commonly used modality in the bronchoscopic management of central airway obstruction and hemoptysis. In experienced hands, APC is considered to be a relatively safe tool. Reported complications associated with APC use are rare and include hemorrhage, airway perforation, or airway fires. Systemic gas embolism has been reported with APC during laparoscopic hepatic surgeries, and we have reported one case of systemic gas embolism with cardiovascular collapse in the past. We now report the first case series of systemic, life-threatening gas embolism occurring as a complication of bronchoscopic application of APC.     

Watermelon stomach: clinical aspects and treatment with argon plasma coagulation

BACKGROUND: Gastric antral vascular ectasia is a disorder whose pathogenetic mechanism is unknown. The endoscopic treatment with argon plasma coagulation has been considered one of the best endoscopic therapeutic options. AIM: To analyze the endoscopic and clinical features of gastric antral vascular ectasia and its response to the argon plasma coagulation treatment. PATIENTS AND METHODS: Eighteen patients were studied and classified into two groups: group 1--whose endoscopic aspect was striped (watermelon) or of the diffuse confluent type; group 2--diffuse spotty nonconfluent endoscopic aspect. RESULTS: Group 1 with eight patients, all having autoimmune antibodies, but one, whose antibodies were not searched for. Three were cirrhotic and three had hypothyroidism. All had gastric mucosa atrophy. In group 2, with 10 patients, all had non-immune liver disease, with platelet levels below 90,000. Ten patients were submitted to argon plasma coagulation treatment, with 2 to 36 months of follow-up. Lesions recurred in all patients who remained in the follow-up program and one did not respond to treatment for acute bleeding control. CONCLUSION: There seem to be two distinct groups of patients with gastric antral vascular ectasia: one related to immunologic disorders and other to non-immune chronic liver disease and low platelets. The endoscopic treatment using argon plasma coagulation had a high recurrence in the long-term evaluation.     

Randomized controlled trial comparing epinephrine injection plus heat probe coagulation versus epinephrine injection plus argon plasma coagulation for bleeding peptic ulcers

BACKGROUND: Epinephrine injection with heat probe coagulation is an effective treatment for bleeding peptic ulcer. Few studies have investigated the efficacy of dual therapy with epinephrine injection plus either heat probe or argon plasma coagulation for high-risk bleeding peptic ulcers. This study compared epinephrine injection plus heat probe coagulation to epinephrine injection plus argon plasma coagulation for the treatment of high-risk bleeding peptic ulcers. METHODS: The study design was prospective, randomized, and controlled. Patients with actively bleeding peptic ulcers, ulcers with adherent clots, or ulcers with nonbleeding visible vessels were randomly assigned to epinephrine injection plus heat probe coagulation or epinephrine injection plus argon plasma coagulation. Patients with previous gastric surgery, malignant ulcers, and unidentifiable ulcers because of torrential bleeding were excluded. The primary outcome measure was recurrence of bleeding. Secondary outcome measures were initial hemostasis, endoscopic procedure duration, number of patients requiring surgery, mortality within 30 days, and ulcer status at 8 week follow-up endoscopy. RESULTS: One hundred ninety-two patients were enrolled; 7 with malignant ulcers were excluded after randomization. One hundred eighty-five cases were analyzed, 97 in the heat probe group and 88 in the argon plasma coagulation group. Patient demographics and ulcer characteristics were comparable between the groups. There was no significant difference in terms of initial hemostasis (95.9% vs. 97.7%), frequency of recurrent bleeding (21.6% vs. 17.0%), requirement for emergency surgery (9.3% vs. 4.5%), mean number of units of blood transfused (2.4 vs. 1.7 units), mean hospital stay (8.2 vs. 7.0 days), and hospital mortality (6.2% vs. 5.7%). Sixty (61.8%) patients in the heat probe group and 52 (52.9%) in the argon plasma coagulation group underwent endoscopy at 8 weeks. There was no significant difference between these groups in the relative frequency of nonhealing ulcer at 8 weeks. CONCLUSION: Epinephrine injection plus argon plasma coagulation is as safe and effective as epinephrine injection plus heat probe coagulation in the treatment of patients with high-risk bleeding peptic ulcers.     

Endoscopic interventions for preneoplastic and neoplastic lesions: mucosectomy,argon plasma coagulation,and photodynamic therapy

The classical treatment of neoplastic lesions is surgical resection. Improved detection of early lesions has offered new therapeutic strategies. Thus, for the last 20 years it has been increasingly attempted to undertake endoscopic resection of such tumors. While there is no doubt that morbidity and mortality are lower than after surgery, it was assumed that the long-term prognosis is not as good as with surgery. Surprisingly, however, the 5-year survival rates are excellent. Therefore, in local mucosal lesions of colon, stomach, and esophagus, endoscopic removal has become standard treatment. In Barrett's esophagus, the treatment modality it is still discussed controversially, despite encouraging results. Since we are yet not able to completely eliminate the premalignant specialized intestinal epithelium of the esophagus, it is still uncertain whether eradication of the malignant or dysplastic lesion is sufficient.     

Cerebral gas embolism from bronchoscopic argon plasma coagulation: a case report

Argon plasma coagulation (APC) is a common and safe bronchoscopic technique used in the management of obstructing lesions and hemorrhage in the central airways. Complications of bronchoscopic APC are uncommon and include hemorrhage, perforation and fire in the airways. While bronchoscopic APC has been reported to cause systemic gas embolization and associated cardiovascular collapse, we report a case of cerebral gas embolization that occurred during bronchoscopic APC and highlight underappreciated potential risk factors for its occurrence.