argon plasma coagulation

Endobronchial treatments are widely used for treating airway obstruction with the goal of relieving large airway obstructions caused by malignant or benign lesions. However, they may be curative in patients with benign conditions. We aimed to evaluate the usefulness of endobronchial argon plasma coagulation (APC) and electrocautery (EC) for treating patients with airway obstruction. Methods: We conducted a retrospective study in the bronchoscopy unit of a training and research hospital. Endobronchial treatment was carried out in 56 evaluable patients between 2007 and 2012. We used a rigid bronchoscope in 18 patients and flexible bronchoscope in 38 patients. General anaesthesia was administered to 32% (18 patients) patients. Bronchogenic carcinoma was seen in 43 patients, metastatic bronchial tumours in 1, and benign airway disease in 12. Obstruction sites were the trachea in 15 patients, main stem bronchi in 28 and lobar bronchi in 5. Eight patients had obstruction at multiple sites. Mean degree of obstruction was 84%. Immediately after the treatment, the mean degree of obstruction was 44%. Mean overall decrease in degree of obstruction was 39%. Post-tretament improvement of dyspnoea was excellent in 31 cases (55%) and moderate in 23 cases (41%); dyspnoea improvement was absent in 2 cases. Three complications (2 cases of respiratory insufficiency, 1 of mediastinal emphysema) were directly related to the endobronchial treatment. Conclusion: APC and EC are effective, rapid and repeatable techniques for treating endoluminal airway lesions and can effectively decrease dyspnoea. ÖZET Semptomatik Hava Yolu Lezyonu Olan Hastalarda Bronkoskopik Tedavi Argon Plazma Koagülasyonu /Elektrokoter Endobronşiyal tedaviler, malign ya da benign lezyonların neden olduğu büyük hava yolu obstrüksiyonlarında palyatif amaçla yaygın olarak kullanılmaktadır. Bu tedaviler benign durumlarda küratif olabilmektedir. Bu çalışmada hava yolu obstrüksiyonlarının tedavisinde endobronşiyal argon plazma koagülasyonu (APC) ve elektrokoterin (EC) yararlılığını değerlendirmeyi amaçladık. Çalışma retrospektif olarak bir eğitim araştırma hastanesi bronkoskopi ünitesinde yürütüldü. 2007-2012 yılları arasında 56 hastaya endobronşiyal tedavi uygulandı. On sekiz hastada rijid, 38 hastada fiberoptik bronkoskop ile işlem yapıldı. Hastaların %32 sinde (18 hastada) genel anestezi uygulandı. Kırküç olguda bronş karsinomu, 1 olguda metastatik tümor, 12 hastada benign hava yolu darlığı mevcuttu. Onbeş hastada trakeada, 28 hastada ana bronşta, 5 hastada lober bronş düzeyinde, 8 hastada birden fazla yerde obstrüksiyon mevcuttu. Obstrük-siyon derecesi ortalaması %84 idi. Tedaviden hemen sonra saptanan obstrüksiyon derecesi ortalaması %44 idi. Obstrüksiyon dere-cesindeki azalmanın ortalaması %39 olarak bulundu. Tedavi sonrası dispnede düzelme 31 olguda(%55) " mükemmel " , 23 olguda(41) " orta düzeyde " saptandı, 2 olguda dispnede düzelme görülmedi. Endobronşiyal tedavi ile ilişkili komplikasyon 3 olguda görüldü.(2 olguda solunum yetmezliği, 1 olguda mediasten anfizemi). APC ve EC endobronşiyal lezyonların tedavisinde kullanılan, dispneyi etkin bir şekilde azaltabilen, hızlı etkili, tekrarlanabilir tetkiklerdir. Anahtar Kelimeler: Hava yolu obstrüksiyonu, Argon plazma koagülasyonu, Elektrokoter, Bronkoskopi

Background:  Solitary rectal ulcer syndrome (SRUS) is an uncommon disorder of evacuation. Management of bleeding ulcers is usually unsatisfactory with conventional treatment. Argon plasma coagulation (APC) has been reported to control bleeding; however, it has not been shown to result in ulcer healing. The aim of the present study was to: (i) to investigate the efficacy and safety of APC in controlling bleeding from SRUS; and (ii) to study its efficacy in the healing of ulcer/s.Methods:  Twenty-four patients with bleeding SRUS diagnosed on clinical, colonoscopic, and histological findings were randomized to receive either standard care alone (12 patients) or to undergo multiple sessions of APC in addition (12 patients). All patients were followed up to determine ulcer healing.Results:  Twenty-four patients with a mean duration of symptoms of 12.6 ± 4.8 months were included. Bleeding was controlled with one (n = 5) or two sessions (n = 7) of APC. Reduction in size and depth of ulcer was noted. Eight out of 12 patients who received APC had complete healing of ulcers after four to eight sessions, carried out 2–4 weeks apart. The remaining four patients had a reduction in size and depth of ulcers compared to their pretreatment appearance. All patients were advised to have a high intake of fluids, fiber and laxatives, and to undergo biofeedback and behavior modification therapy in addition to the treatment.Conclusions:  APC controls bleeding in patients with SRUS and it also improves the healing of these ulcers.

Background:  Solitary rectal ulcer syndrome (SRUS) is an uncommon disorder of evacuation. Management of bleeding ulcers is usually unsatisfactory with conventional treatment. Argon plasma coagulation (APC) has been reported to control bleeding; however, it has not been shown to result in ulcer healing. The aim of the present study was to: (i) to investigate the efficacy and safety of APC in controlling bleeding from SRUS; and (ii) to study its efficacy in the healing of ulcer/s.Methods:  Twenty-four patients with bleeding SRUS diagnosed on clinical, colonoscopic, and histological findings were randomized to receive either standard care alone (12 patients) or to undergo multiple sessions of APC in addition (12 patients). All patients were followed up to determine ulcer healing.Results:  Twenty-four patients with a mean duration of symptoms of 12.6 ± 4.8 months were included. Bleeding was controlled with one (n = 5) or two sessions (n = 7) of APC. Reduction in size and depth of ulcer was noted. Eight out of 12 patients who received APC had complete healing of ulcers after four to eight sessions, carried out 2–4 weeks apart. The remaining four patients had a reduction in size and depth of ulcers compared to their pretreatment appearance. All patients were advised to have a high intake of fluids, fiber and laxatives, and to undergo biofeedback and behavior modification therapy in addition to the treatment.Conclusions:  APC controls bleeding in patients with SRUS and it also improves the healing of these ulcers.

Watermelon stomach or gastric antral vascular ectasia (GAVE) is a rare but well-recognized cause of gastrointestinal blood loss, which typically affects elderly women. Historically patients were treated with antrectomy but this has been largely replaced by endoscopic therapy such as Nd:YAG laser. Argon plasma coagulation (APC) is a new noncontact electocoagulation technique which has several theoretical advantages over laser. The objective of this study was to assess the efficacy of APC in treating GAVE. We retrospectively reviewed the case-records of five patients (four women, one man) with iron deficiency anaemia or gastrointestinal blood loss due to GAVE who were treated with APC and for whom a follow-up of more than 12 months was available. Four patients were transfusion-dependent. Their mean age was 71 years (range 58 - 83). The mode of presentation, number of treatment sessions, response to therapy and recurrence (if any) were recorded. A mean of 2.6 treatment sessions per patient were required. All patients had an endoscopically observed response to therapy and all patients had a sustained rise in hemoglobin level after treatment. Transfusion dependence ceased in all patients. After a mean follow-up of 20 months GAVE recurred in two patients (40 %). Both patients responded to further APC treatment. No major complications were recorded. APC is a safe and effective short-term treatment for GAVE. The natural history of the condition is uncertain, and at medium-term follow-up GAVE is found to recur in a substantial number of patients treated with APC. Re-treatment with APC is an option in these patients.

This study sought to identify the Social Representations of Obesity among 15 individuals who underwent bariatric surgery through the Roux-en-Y Gastric Bypass (RYGB) method and were subjected to Argon Plasma Coagulation (APC) due to weight relapse. Data were collected through interviews and analyzed via Descending Hierarchical Classification. Obesity was associated with physical limitations and difficulties in social relationships. Prejudice and difficulty in changing habits are associated with the choice to undergo surgical treatment and to weight relapse. The suffering that goes along with obesity and the difficulty in changing habits seem to be associated with the search for surgical help.

The laryngeal mask airway (LMA) can be used for gastroscopy, but its use can result in loss of the seal and/or displacement of the cuff. We describe an LMA that was specifically modified for gastroscopy and report its use in a patient with an esophageal tumor. The modified LMA has (a) a second tube that allows instruments to be directed toward the esophagus and (b) a second cuff mounted on the dorsal surface that increases the efficacy of the seal with the larynx. A 78-year-old man weighing 65 kg presented with a large mediastinal adenocarcinoma that was infiltrating the lateral wall of the thoracic esophagus. An esophagoscopy under anesthesia was planned to debulk the tumor. The modified LMA was inserted easily following induction with propofol. Anesthesia was maintained with propofol and 50% O2 in air and spontaneous ventilation. A lubricated 10.5-mm external diameter gastroscope was inserted into the second tube and passed easily into the esophagus. The tumor was successfully debulked using a polypectomy snare and an argon plasma coagulator. There was no loss of seal or displacement of the cuff, and the patient was stable throughout the procedure. We conclude that gastroscopy is feasible with the modified LMA. The device has a potential application in patients who require ventilatory support during gastroscopy.

We report a case of a 42-year-old woman with systemic lupus erythematosus and chronic kidney disease stage 5 undergoing continuous ambulatory peritoneal dialysis, presenting asthenia, dizziness, abdominal pain and small efforts dyspnea. After a complete physical and clinical examination, including laboratory tests, esophagogastroduodenal endoscopy and gastric lesions biopsy, she was diagnosed with gastric antral vascular ectasia. We are facing a rare case of antral vascular ectasia in a patient associating both chronic kidney disease and autoimmune disease.

Background and study aimsGastric antral vascular ectasia (GAVE) is a distinct vascular abnormality, mainly involving the gastric antrum. It is a rare but well-known cause of occult gastrointestinal bleeding. Various endoscopic treatment modalities have been tried in this condition. The aim of the study is to show the long-term effect of argon plasma coagulation (APC) on GAVE.