• Gastric cancer
• appetite
• dumping syndrome
• dysphagia
• esophageal cancer
• gastric outlet obstruction
• gut hormones
• nutrition
• surgery
• survivorship

• Humans
• Esophageal Neoplasms/therapy
• Esophageal Neoplasms/physiopathology
• Esophageal Neoplasms/complications
• Esophageal Neoplasms/mortality
• Stomach Neoplasms/therapy
• Stomach Neoplasms/physiopathology
• Stomach Neoplasms/complications
• Stomach Neoplasms/mortality
• Nutritional Status
• Deglutition Disorders/etiology
• Deglutition Disorders/therapy
• Deglutition Disorders/physiopathology
• Nutritional Support
• Malnutrition/physiopathology
• Malnutrition/therapy
• Malnutrition/etiology
• Malnutrition/diagnosis
• Nutrition Assessment
• Treatment Outcome

• Humans
• Angiodysplasia/complications
• Colonic Diseases/etiology
• Colonoscopy/methods
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Hemostatics/administration & dosage
• Peptides/administration & dosage
• Rectal Diseases/etiology

• argon plasma coagulation
• colonoscopy
• endoscopic mucosal resection
• snare tip soft coagulation

• Chemotherapy
• Cryotherapy
• Dysphagia
• Esophageal cancer
• Esophageal stent
• Palliation
• Quality of life
• Radiotherapy

• Humans
• Deglutition Disorders/etiology
• Deglutition Disorders/therapy
• Esophageal Neoplasms/complications
• Esophageal Neoplasms/therapy
• Endoscopy/adverse effects
• Photochemotherapy
• Palliative Care
• Stents/adverse effects

• cryotherapy
• esophageal cancer
• external beam radiation therapy
• self-expandable metal stent

• funding

Thermal damage to the muscle layer during mucosal application of argon plasma coagulation (APC) may be avoided by creating a fluid cushion within the submucosal layer, but the minimum injection volume needed or the ideal injection fluid are yet to be established. We conducted a systematic ex vivo study with this aim.

All experiments were performed in an ex vivo porcine gastrointestinal tract model. Five different fluids (saline, Glyceol, Gelafundin, Voluven, and Eleview) of different volumes were injected into the submucosa of different parts of the gastrointestinal tract. APC was applied to the mucosa at different power settings. Immediately after APC treatment, the temperature was measured through a thermocouple placed inside the fluid cushion, just on top of the muscle layer. The minimum volume of fluid needed to protect the muscle layer from thermal damage was determined.

There was no difference in the temperature measured among the different injection fluids at the surface of the muscle, in all the locations, at equal injection volumes and power settings. The minimum amounts of fluid needed to protect the muscle layer were 2 and 3 mL for power settings of 30-90 W and 90-120 W, respectively.

Normal saline and 4 commercially available submucosal injection fluids possess similar thermal protective effects. To reduce the likelihood of thermal damage to deeper layers when APC is applied, a minimum injection volume of 3 mL is recommended if less than 90 W power will be utilized over 3 sec.

• Argon plasma coagulation
• ablation
• endoscopy
• submucosal injection

• argon plasma coagulation
• endoscopic band ligation
• gastric antral vascular ectasia
• radiofrequency ablation

Postprocedural bleeding is known to be relatively low after argon plasma coagulation (APC) for gastric neoplasms; however, there are few studies proving the effect of antithrombotic agents. This study aimed to analyze the incidence of delayed bleeding (DB) based on antithrombotic agents administered and to identify the risk factors for DB in APC for gastric tumors.

A total of 785 patients with 824 lesions underwent APC for single gastric neoplasm between January 2011 and January 2018. After exclusion, 719 and 102 lesions were classified as belonging to the non-antithrombotics (non-AT) and AT groups, respectively. The clinical outcomes were compared between the two groups, and we determined the risk factors for DB in gastric APC.

Of the total 821 cases, DB occurred in 20 cases (2.4%) 17 cases in the non-AT group and three cases in the AT group (2.4% vs 2.9%, p=0.728). Multivariate analysis of the risk factors for DB confirmed the following significant, independent risk factors male sex (odds ratio, 7.66; 95% confidence interval, 1.02 to 57.69; p=0.048) and chronic kidney disease (odds ratio, 4.51; 95% confidence interval, 1.57 to 13.02; p=0.005). Thromboembolic events and perforation were not observed in all patients regardless of whether they took AT agents.

AT therapy is acceptably safe in gastric APC because it does not significantly increase the incidence of DB. However, patients with chronic kidney disease or male sex need to receive careful follow-up on the incidence of post-APC bleeding.

• Antithrombotic therapy
• Argon plasma coagulation
• Stomach neoplasm

• Anemia, iron-deficiency
• Argon plasma coagulation
• Endoscopic band ligation
• Gastric antral vascular ectasia
• Retrospective study

• Barrett’s esophagus
• Outcomes
• Radiofrequency ablation

• Argon plasma coagulation
• Endoscopic resection
• Gastrectomy
• Neoplasms
• Stomach

• Cirrhosis
• Gastric antral vascular ectasia
• Gastrointestinal bleeding
• Therapeutic endoscopy
• Varices

• argon plasma coagulation
• cost-effectiveness
• endoscopic submucosal dissection
• low-grade dysplasia

• Aged
• Argon Plasma Coagulation/economics
• Cost-Benefit Analysis
• Dissection/economics
• Endoscopic Mucosal Resection/economics
• Female
• Gastric Mucosa/pathology
• Gastric Mucosa/surgery
• Gastroscopy/economics
• Humans
• Male
• Middle Aged
• Precancerous Conditions/economics
• Precancerous Conditions/pathology
• Precancerous Conditions/surgery
• Retrospective Studies
• Stomach Neoplasms/economics
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery

Argon plasma coagulation (APC) and helium plasma coagulation (HPC) are electrosurgical techniques that provide noncontact monopolar electrothermal haemostasis. Although these techniques have been widely used clinically during the last three decades, their in vivo effects on liver tissue remain unclear.

We investigated the effects of different power levels (10–100 W) of APC and HPC on liver coagulation in 11 Landrace pigs. Capillary blood flow and capillary blood flow velocity were recorded with a combined laser Doppler flowmeter and spectrophotometer. The temperature, clinical biochemical parameters, blood gas parameters, bile duct-sealing effect, and coagulation depth were measured.

APC and HPC significantly reduced the capillary blood flow and capillary blood flow velocity compared with baseline flow. No significant temperature change was measured on the liver surface immediately after coagulation. The clinical biochemical and blood gas parameters were not different before and after coagulation. The coagulation depth was positively correlated with the device power setting.

These results prove that APC and HPC provide sufficient superficial haemostasis. No significant systemic effects occurred following coagulation. The depth of the coagulation effect can be controlled through selection of the output power level.

• Argon plasma coagulation
• helium plasma coagulation
• liver surgery
• plasma coagulation

• ablation techniques
• argon plasma coagulation
• gastric neoplasm

• ovarian cancer
• tumor ablation
• cytoreductive surgery

• Animals
• Argon Plasma Coagulation/adverse effects
• Argon Plasma Coagulation/instrumentation
• Argon Plasma Coagulation/methods
• Cytoreduction Surgical Procedures/adverse effects
• Cytoreduction Surgical Procedures/instrumentation
• Cytoreduction Surgical Procedures/methods
• Female
• Intestinal Mucosa/surgery
• Intestine, Small/surgery
• Laser Coagulation/adverse effects
• Laser Coagulation/instrumentation
• Laser Therapy/adverse effects
• Laser Therapy/instrumentation
• Laser Therapy/methods
• Models, Animal
• Plasma Gases/therapeutic use
• Swine

• P30 CA008748 NCI NIH HHS

• Complications
• Endoscopy
• Gastrointestinal
• Therapeutic

• Barrett Esophagus/surgery
• Colonoscopy/adverse effects
• Dilatation
• Foreign Bodies/therapy
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Gastroscopy/adverse effects
• Hemostasis, Endoscopic/adverse effects
• Humans
• Intestinal Perforation/etiology
• Stents

• Anemia/etiology
• Anemia/therapy
• Anemia/veterinary
• Angiodysplasia/therapy
• Angiodysplasia/veterinary
• Animals
• Argon Plasma Coagulation/veterinary
• Blood Transfusion/veterinary
• Colonic Diseases/complications
• Colonic Diseases/therapy
• Colonic Diseases/veterinary
• Colonoscopy/veterinary
• Dog Diseases/etiology
• Dog Diseases/therapy
• Dogs
• Gastrointestinal Hemorrhage/complications
• Gastrointestinal Hemorrhage/therapy
• Gastrointestinal Hemorrhage/veterinary
• Male

• argon plasma coagulation (APC)
• case-control study
• endoscopic injection sclerotherapy (EIS)
• recurrent esophageal varices
• telangiectasia

• Argon plasma coagulation
• Liver disease
• Portal hypertension

• Argon plasma coagulation
• bleeding
• endoscopy
• gastrointestinal cancer
• gastrointestinal hemorrhage
• hemostasis
• mortality
• tumor

Argon plasma coagulation (APC) has some merits in the treatment of gastric neoplasms including a shorter operative time and fewer complications compared with endoscopic mucosal resection or endoscopic submucosal dissection. However, there are few reports on the outcomes of gastric neoplasms treated using APC. The aim of this study was to evaluate APC in the treatment of early gastric neoplasms in terms of clinical efficacy, safety, and local recurrence.

We enrolled 28 patients who received APC therapy at the Kyungpook National University Hospital between May 2007 and April 2013. Clinical outcomes were analyzed.

The median follow-up period was 24.8 months (range, 2 to 78). Among the 28 lesions treated using the APC procedure, tumor recurrence was encountered in seven lesions (25.0%). Recurrence was found in 50% (5/10) of single APC cases and 11% (2/18) of rescue APC cases. The mean time to recurrence was 16.1 months (range, 2 to 78). There were no serious APC-related complications such as perforation, bleeding, or infection.

APC therapy can be a useful treatment with a favorable safety profile for patients with early gastric neoplasms. However, further studies are necessary to determine the long-term prognosis of patients undergoing this treatment.

• Argon plasma coagulation
• Early gastric cancer
• Endoscopic treatment
• Recurrence

Endoscopic techniques are gaining popularity in the management of colorectal polyps and occasionally superficial cancers. While their use is in many times palliative, they have proven to be curative in carefully selected patients with polyps or malignancies, with less morbidity than radical resection. However, one should note that data supporting local and ablative therapies for colorectal cancer is scarce and may be subject to publication bias. Therefore, for curative intent, these techniques should only be considered in highly select cases as higher rates of local recurrences have also been reported. The aim of this review is to explain the different modalities of local and ablative therapies specific to colorectal neoplasia and explain the indications and circumstances where they have been most successful.

• Angiodysplasia/diagnosis
• Angiodysplasia/epidemiology
• Angiodysplasia/etiology
• Angiodysplasia/therapy
• Electrocoagulation
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/epidemiology
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Humans
• Octreotide/therapeutic use
• Thalidomide/therapeutic use

Gastric antral vascular ectasia (GAVE) is an uncommon but often severe cause of upper gastrointestinal (GI) bleeding, responsible of about 4% of non-variceal upper GI haemorrhage. The diagnosis is mainly based on endoscopic pattern and, for uncertain cases, on histology. GAVE is characterized by a pathognomonic endoscopic pattern, mainly represented by red spots either organized in stripes radially departing from pylorus, defined as watermelon stomach, or arranged in a diffused-way, the so called honeycomb stomach. The histological pattern, although not pathognomonic, is characterized by four alterations: vascular ectasia of mucosal capillaries, focal thrombosis, spindle cell proliferation and fibrohyalinosis, which consist of homogeneous substance around the ectatic capillaries of the lamina propria. The main differential diagnosis is with Portal Hypertensive Gastropathy, that can frequently co-exists, since about 30% of patients with GAVE co-present a liver cirrhosis. Autoimmune disorders, mainly represented by Reynaud’s phenomenon and sclerodactyly, are co-present in about 60% of patients with GAVE; other autoimmune and connective tissue disorders are occasionally reported such as Sjogren’s syndrome, systemic lupus erythematosus, primary biliary cirrhosis and systemic sclerosis. In the remaining cases, GAVE syndrome has been described in patients with chronic renal failure, bone marrow transplantation and cardiac diseases. The pathogenesis of GAVE is still obscure and many hypotheses have been proposed such as mechanical stress, humoural and autoimmune factors and hemodynamic alterations. In the last two decades, many therapeutic options have been proposed including surgical, endoscopic and medical choices. Medical therapy has not clearly shown satisfactory results and surgery should only be considered for refractory severe cases, since this approach has significant mortality and morbidity risks, especially in the setting of portal hypertension and liver cirrhosis. Endoscopic therapy, particularly treatment with Argon Plasma Coagulation, has shown to be as effective and also safer than surgery, and should be considered the first-line treatment for patients with GAVE-related bleeding.

• Gastric antral vascular ectasia
• Bleeding
• Watermelon stomach
• Argon plasma coagulation

AIM: To evaluate the usefulness and safety of argon plasma coagulation (APC) for superficial esophageal squamous-cell carcinoma (SESC) in high-risk patients.

METHODS: We studied 17 patients (15 men and 2 women, 21 lesions) with SESC in whom endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and open surgery were contraindicated from March 1999 through February 2009. None of the patients could tolerate prolonged EMR/ESD or open surgery because of severe concomitant disease (e.g., liver cirrhosis, cerebral infarction, or ischemic heart disease) or scar formation after EMR/ESD and chemoradiotherapy. After conventional endoscopy, an iodine stain was sprayed on the esophageal mucosa to determine the lesion margins. The lesion was then ablated by APC. We retrospectively studied the treatment time, number of APC sessions per site, complications, presence or absence of recurrence, and time to recurrence.

RESULTS: The median duration of follow-up was 36 mo (range: 6-120 mo). All of the tumors were macroscopically classified as superficial and slightly depressed type (0-IIc). The preoperative depth of invasion was clinical T1a (mucosal cancer) for 19 lesions and clinical T1b (submucosal cancer) for 2. The median treatment time was 15 min (range: 10-36 min). The median number of treatment sessions per site was 2 (range: 1-4). The median hospital stay was 14 d (range: 5-68 d). Among the 17 patients (21 lesions), 2 (9.5%) had recurrence and underwent additional APC with no subsequent evidence of recurrence. There were no treatment-related complications, such as bleeding or perforation.

CONCLUSION: APC is considered to be safe and effective for the management of SESC that cannot be resected endoscopically because of underlying disease, as well as for the control of recurrence after EMR and local recurrence after chemoradiotherapy.

• Argon plasma coagulation
• Superficial esophageal cancer
• Squamous-cell carcinoma
• High-risk patient
• Endoscopic therapy

AIM: To evaluate the application value of Phloroglucinol for Injection in special endoscopic treatment for esophageal diseases, such as narrow-band imaging (NBI) magnifying endoscopy, endoscopic ultrasonography (EUS) and argon plasma coagulation therapy.

METHODS: Ninety patients who were willing to accept NBI magnifying endoscopy, EUS or argon plasma coagulation therapy for esophageal diseases (e.g., Barrett's esophagus or early esophageal cancer) were randomly divided into two groups, one using phloroglucinol and the other using 654-2. The frequency of esophagism, operating time and side effects were compared between the two groups.

RESULTS: Compared to the 654-2 group, the frequency of esophagism was significantly lower (1.45 c.p.m ± 0.68 c.p.m vs 2.88 c.p.m ± 1.48 c.p.m, P < 0.01) and the operating time was significantly shorter (174.77 s ± 48.63 s vs 225.00 s ± 59.48 s, P < 0.01) in the phloroglucinol group. Patients of the 654-2 group developed adverse side effects such as dry mouth (5 cases), transient urinary retention (2 cases) and obviously increased heart rate, while patients of the phloroglucinol groups did not.

CONCLUSION: Phloroglucinol is likely capable of effectively relieving esophagism and shortening the operating time in special endoscopic treatment for esophageal diseases and causes no adverse side effects like increased heart rate, dry mouth and urinary retention.

• Phloroglucinol
• Anisodamine hydrobromide
• Endoscopic ultrasonography
• Narrow-brand imaging endoscopy

• Argon plasma coagulation
• Endoscopic band ligation
• Gastric antral vascular ectasia
• Liver cirrhosis