scholarly journals Efficacy and Safety of Argon Plasma Coagulation for Hemorrhagic Chronic Radiation Proctopathy: A Systematic Review

2018 ◽  
Vol 2018 ◽  
pp. 1-14 ◽  
Author(s):  
Yanan Peng ◽  
Haizhou Wang ◽  
Juerong Feng ◽  
Shilin Fang ◽  
Meng Zhang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Large Scale ◽  
Gas Flow ◽  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
Effective Rate ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
Plasma Coagulation ◽  
Chronic Radiation

Hemorrhagic chronic radiation proctopathy (CRP) is a common complication after pelvic radiotherapy in patients with prostate or gynecological cancers. This systematic review was conducted to evaluate the efficacy and safety of argon plasma coagulation (APC) in treating hemorrhagic CRP. The databases of PubMed, Embase, and Cochrane Library were searched for related studies from inception to July 2017. Finally, 33 studies were identified with a total of 821 hemorrhagic CRP patients. After APC treatment, hemoglobin levels increased from 7.7–13.4 g/L to 11–14 g/L (including 15 studies). All (n=33) studies reported an effective rate in rectal bleeding, among which five studies had a rate of 100%. Short-term complications were reported in 31 studies, while long-term complications in 33 studies and no complication in 11 studies. As for the severe complications, perforation was reported by 2 out of 33 studies, and the incidences were 3.3% (1/30) and 3.7% (1/27), respectively. As for APC setting, argon gas flow rate (median 1.5 L/min) and electric power (median 50 W) had no significant influence on complications and hemostasis. In conclusion, current literature indicated that APC therapy was an effective and safe strategy for hemorrhagic CRP, and large-scale prospective studies are needed to warrant our study.

Argon Plasma Coagulation: Elucidation of the Mechanism of Gas Embolism

Respiration ◽  
2021 ◽  
pp. 1-5
Author(s):  
Erik E. Folch ◽  
Catherine L. Oberg ◽  
Atul C. Mehta ◽  
Adnan Majid ◽  
Colleen Keyes ◽  
...  
Keyword(s):  
Direct Contact ◽  
Gas Flow ◽  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
Tracheobronchial Tree ◽  
Bleeding Complications ◽  
Gas Transfer ◽  
Gas Embolism ◽  
Associated Gas ◽  
Plasma Coagulation

<b><i>Background:</i></b> Argon plasma coagulation (APC) is a tool used in the management of tracheobronchial obstruction or bleeding. Complications include gas embolism which can cause devastating effects including hemodynamic instability, cardiac arrest, and stroke. Multiple theories as to how gas embolism occurs with APC have been postulated; however, none have identified the exact mechanism. <b><i>Objectives:</i></b> To identify the mechanism by which APC causes gas embolism in the tracheobronchial tree. <b><i>Methods:</i></b> Using an explanted porcine tracheobronchial tree with lung parenchyma, the APC catheter was applied through noncontact and direct contact to the endobronchial airway mucosa via flexible bronchoscopy. This was done at multiple gas flow settings and pulse durations. Visual changes in the mucosa were photographed, videoed, and described. <b><i>Results:</i></b> Gross evidence of submucosal gas transfer occurred when the APC catheter was in direct contact with the mucosa at all gas flow settings in all applications, despite using shorter pulse durations. Whenever the catheter was not in contact with the mucosa, there was no transfer of gas at any gas flow setting or pulse duration. <b><i>Conclusions:</i></b> Direct mucosal contact with the APC probe leads to submucosal gas deposition and is a likely mechanism for gas entry into the intravascular space. In reported cases of APC-associated gas embolism, presence of a vascularized endobronchial tumor may have increased the risk of gas tracking into the intravascular space. Care should be taken when applying APC during brisk bleeding or limited vision, as inadvertent mucosal contact may occur and could increase the risk of gas embolism.

scholarly journals Endoscopic treatment of gastric and duodenal angiodysplasias by elastic rings ligation

2012 ◽  
Vol 140 (3-4) ◽  
pp. 168-172
Author(s):  
Sasa Grgov ◽  
Perica Stamenkovic ◽  
Dejan Janjic
Keyword(s):  
Endoscopic Treatment ◽  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
Active Bleeding ◽  
Average Period ◽  
Efficacy And Safety ◽  
Plasma Coagulation ◽  
Heater Probe ◽  
Endoscopic Ligation

Introduction. The most frequently applied methods of endoscopic treatment of angiodysplasias, such as argon plasma coagulation, multipolar coagulation and heater probe, proved to be effective with certain shortcomings and the possibility of complications. There are very scarce data in the literature about the treatment of angiodysplasias with endoscopic ligature. Objective. The aim of the study was to examine the efficacy and safety of endoscopic treatment of gastric and duodenal angiodysplasias by ligation with elastic rings. Methods. In 12 patients (10 male and 2 female, mean age 65.9 years) the endoscopic ligation of gastric and duodenal angiodysplasias was applied. Eight patients (66.6%) had solitary angiodysplasias in the stomach, two patients (16.6%) had solitary angiodysplasias in the descending part of the duodenum and two patients (16.6%) had multiple angiodysplasias in the stomach and duodenum. Two patients (16.6%) had active bleeding from angiodysplasias, while 10 patients (83.3%) had recent bleeding. We used the Cook Endoscopy system with 4 or 6 elastic rings for endoscopic ligation of angiodysplasias. Patients were under follow-up after 2-3 days, 30 days and then every 6 months following the endoscopic ligation of angiodysplasias. Results. Active bleeding from angiodysplasias was stopped in two patients (100%) by endoscopic ligation with elastic rings. The average number of applied ligation sessions in our 12 patients was 1.6, with an average of 1.8 ligatures per session. There were no complications after ligation of angiodysplasias. Recurrence of bleeding occurred in one patient (8.3%) with multiple gastric and duodenal angiodysplasias. The average period of follow-up of patients was 22.8?17.6 months. Conclusion. Endoscopic ligation with elastic rings can be effective and safe for treatment especially of solitary gastric and duodenal angiodysplasias.

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