ABSTRACT
BACKGROUND AND AIMS: Argon plasma coagulation (APC) could be considered a treatment modality for small gastric low-grade dysplasia (LGD) instead of endoscopic resection. Our study investigated the clinical outcomes of APC for treating gastric LGD and associated variables with local recurrence. METHODS: This study included 911 patients who underwent APC for gastric neoplasms at the tertiary hospital from July 2007 to March 2022 with a minimal follow-up of 12 months. Of these patients, 112 without any information about Helicobacter pylori infection status, 164 who underwent APC for salvage therapy, 5 with high-grade dysplasia, and 12 with cancer were excluded. Through a retrospective review of medical data, the clinical outcomes and variables associated with the local recurrence were analyzed. RESULTS: A total of 618 patients with LGD (median age, 64 years) were followed up for a median of 30 months, and local recurrence has happened in 21 (3.4%) patients. Multivariate analysis showed that lesion size (hazard ratio, 1.06; 95% confidential interval, 1.01-1.12) was associated with the local recurrence. Among 557 lesions smaller than 10 mm, local recurrence was found in 14 (2.6%) cases, and local recurrence was found in 7 (9.5%) cases of 109 tumors larger than 10 mm (P < .004). CONCLUSIONS: In gastric LGD smaller than 10 mm without scars, APC is a good treatment modality in place of endoscopic resection. However, when a lesion is larger, APC should be selected carefully with close monitoring.
Subject(s)
Argon Plasma Coagulation , Neoplasm Recurrence, Local , Stomach Neoplasms , Humans , Argon Plasma Coagulation/methods , Male , Middle Aged , Female , Stomach Neoplasms/surgery , Stomach Neoplasms/pathology , Retrospective Studies , Aged , Adult , Treatment Outcome , Tumor Burden , Gastroscopy/methods , Aged, 80 and over , Neoplasm GradingABSTRACT
BACKGROUND: This study performed a meta-analysis to compare the safety and efficacy of argon plasma coagulation (APC) concerning suture (SUT) and surgery (SUR). METHODS: The One-Way tests were applied, with p <0.05 significant. The value of R2 was analyzed (heterogeneity), and the risk of bias of articles was evaluated. RESULTS: A total of 34 studies were found, eight about APC, twenty about SUT, and six about SUR. For the percentage of Weight Loss Regained (%WLR), the means for APC, SUT, and SUR were 19.39 ± 10.94, 26.06 ± 16.71, and 17.05 ± 9.85, and for success rate (%SR), the means were 89.75 ± 16.75, 86.80 ± 11.44, and 76.00 ± 21.57, respectively with p >0.05, with R2 ≥ 50%. CONCLUSION: The APC proved to be efficient and safe like the other techniques.
Subject(s)
Argon Plasma Coagulation , Bariatric Surgery , Humans , Argon Plasma Coagulation/methods , Prospective Studies , Weight Gain , Sutures , Weight Loss , Treatment OutcomeABSTRACT
CASE PRESENTATION: A 57-year-old man with a history of polysubstance use presented with shortness of breath, wheezing, productive cough, subjective fever, and chills of 3-day duration. Additionally, he reported worsening shortness of breath for the last 3 months. Of note, the patient was reported to have had, in the previous 6 months, two episodes of pneumonia that was treated with antibiotics and steroids. He was also diagnosed several years prior with adult-onset asthma due to intermittent wheezing and was prescribed an albuterol inhaler. The albuterol did not help relieve his wheezing, and he stopped refilling it.
Subject(s)
Argon Plasma Coagulation/methods , Biopsy/methods , Bronchoscopy/methods , Papilloma , Tracheal Diseases , Tracheal Stenosis , Aged , Diagnosis, Differential , Dyspnea/diagnosis , Dyspnea/etiology , Humans , Immunohistochemistry , Male , Papilloma/pathology , Papilloma/physiopathology , Respiratory Sounds/diagnosis , Respiratory Sounds/etiology , Tomography, X-Ray Computed/methods , Tracheal Diseases/pathology , Tracheal Diseases/physiopathology , Tracheal Stenosis/diagnosis , Tracheal Stenosis/physiopathology , Treatment OutcomeABSTRACT
RATIONALE: An esophago-bronchial fistula is one of the rare postoperative complications of esophageal cancer. There are various medical treatments, including suturing, endoscopic clip, and fibrin glue. However, these treatments often lead to unsatisfactory results, causing physicians to opt for surgical alternatives. The Over-The-Scope-Clipping (OTSC) system offers an alternative method for fistula closure. It can capture a large amount of tissue and is able to compress the lesion until it has fully healed. However, data indicating the efficacy of OTSC for esophago-bronchial fistula are limited. PATIENT CONCERNS: A 64-year-old man presented with an esophago-bronchial fistula after surgery for esophageal cancer. We chose to use a stent as the first line of treatment, but the fistula did not close. DIAGNOSES: Intractable esophago-bronchial fistula associated with esophageal surgery. INTERVENTIONS AND OUTCOMES: On the 94th postoperative day, fistula closure with OTSC was performed, and no leakage of the contrast agent was observed during fluoroscopy. We also attempted to close the fistula by combining OTSC and argon plasma coagulation (APC) to burn off the scar tissue from around the fistula. The fistula gradually shrank after a total of 4 rounds of OTSC, and closure of the fistula was achieved on the 185th postoperative day. There were no adverse events during the treatment of this case. LESSONS: We demonstrate that OTSC is useful in the management of esophago-bronchial fistulas, and may become a standard procedure for the endoscopic treatment of esophago-bronchial fistulas, replacing the use of stents, clips, or glue.
Subject(s)
Argon Plasma Coagulation/methods , Bronchial Fistula/surgery , Esophageal Fistula/surgery , Suture Techniques/instrumentation , Bronchial Fistula/diagnostic imaging , Bronchial Fistula/etiology , Esophageal Fistula/diagnostic imaging , Esophageal Fistula/etiology , Esophageal Neoplasms/surgery , Humans , Male , Middle Aged , Postoperative Complications/diagnostic imaging , Postoperative Complications/surgery , Treatment OutcomeABSTRACT
AIMS: To evaluate the efficacy of medical thoracoscopy-assisted argon plasma coagulation in association with autologous blood pleurodesis in spontaneous pneumothorax. PATIENTS AND METHODS: Three male patients with spontaneous pneumothorax were treated; medical thoracoscopy-assisted argon plasma coagulation combined with autologous blood pleurodesis was conducted for all patients whose duration of the air leak exceeded 7 days. We systematically reviewed all of the relevant literature to analyze and sum up the treatments of secondary spontaneous pneumothorax. RESULTS: The air leaks were all sealed and no recurrence of pneumothorax was reported. No complications of fever, bleeding, or signs of infection were observed during the process. CONCLUSION: The authors believe that the combination of medical thoracoscopy-assisted argon plasma coagulation and autologous blood pleurodesis is safe and effective. However, due to the number of patients included in this uncontrolled case study, more cases will be collected in the future.The reviews of this paper are available via the supplemental material section.
Subject(s)
Argon Plasma Coagulation/methods , Pleurodesis/methods , Pneumothorax/therapy , Thoracoscopy/methods , Aged , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
BACKGROUND AND AIM: Endoscopic post-papillectomy bleeding occurs in 3% to 20% of the cases, and delayed bleeding is also problematic. However, there is no consensus on how to reduce delayed post-papillectomy bleeding. The aim of this study was to evaluate the efficacy of prophylactic argon plasma coagulation (APC) to minimize delayed bleeding and reduce the persistence of residual tumors after endoscopic papillectomy. METHODS: In a prospective pilot study of patients with benign ampullary tumors, the prophylactic APC group underwent APC at the resection margin following a conventional snaring papillectomy. Then, 24 h later after the papillectomy, all patients underwent a follow-up duodenoscopy to identify post-papillectomy bleeding and were followed up until 12 months. The main outcomes were the delayed (≥24 h) post-papillectomy bleeding rate and the tumor persistence rate. RESULTS: The delayed post-papillectomy bleeding rate was 30.8% (8/26) in the prophylactic APC group and 21.4% (6/28) in the non-APC group (P = 0.434). The post-procedure pancreatitis rates were 23.1% (6/26) and 35.7% (10/28), respectively (P = 0.310). The rate of tumor persistence did not differ between the two groups at 1 month (12.5% vs 7.4%, P = 0.656), 3 months (4.2% vs 3.7%, P = 1.00), 6 months (8.3% vs 3.7%, P = 0.595), and 12 months (0% vs 3.7%, P = 1.00). There were no procedure-related mortalities or serious complications. CONCLUSION: Prophylactic APC may not be effective in reducing delayed post-papillectomy bleeding or remnant tumor ablation immediately after conventional papillectomy (Clinical trial registration-cris.nih.go.kr; KCT0001955).
Subject(s)
Adenocarcinoma/surgery , Ampulla of Vater/surgery , Argon Plasma Coagulation/methods , Common Bile Duct Neoplasms/surgery , Postoperative Hemorrhage/prevention & control , Sphincterotomy, Endoscopic/adverse effects , Adult , Aged , Female , Humans , Male , Middle Aged , Prospective Studies , Sphincterotomy, Endoscopic/methodsABSTRACT
BACKGROUND/AIMS: Endoscopic resection is the standard treatment for superficial esophageal squamous-cell neoplasia (SESCN). However, we encounter patients in whom endoscopic resection is difficult to perform. We retrospectively studied the usefulness of argon plasma coagulation (APC) in patients with SESCN. MATERIALS AND METHODS: The study comprised 45 patients with SESCN (81 lesions) who underwent APC in our hospital from March 1999 through August 2016. Clinicopathological characteristics, treatment time, the presence or absence of metastasis and recurrence, adverse events, and outcomes were studied. RESULTS: The median follow-up was 40 months. The median age was 70 years. The tumor diameter was 10 mm or longer in 48 lesions and less than 10 mm in 33 lesions. The median treatment time was 22 minutes. The reasons for selecting APC were as follows: technical difficulty caused by the presence of metachronous multiple lesions in the radiation field after chemoradiotherapy or close proximity to the ulcer scar remaining after endoscopic treatment in 49 lesions (60.4%), and the presence of underlying diseases in 26 lesions (32.0%). Adverse events occurred in 2 patients (4.4%) who had hypoxemia due to over-sedation. Two lesions (2.5%) recurred locally but could be locally controlled by additional APC. No patient had metastasis or recurrence or died of esophageal neoplasia. The 3-year overall survival rate was 87.0%, and the 3-year recurrence-free survival rate was 97.2%. CONCLUSION: APC can be a useful treatment option for SESCN in patients with a limited life expectancy, poor performance status, or technical difficulty in resection of superficial neoplasms.
Subject(s)
Argon Plasma Coagulation/methods , Carcinoma, Squamous Cell/therapy , Esophageal Neoplasms/therapy , Aged , Aged, 80 and over , Argon Plasma Coagulation/mortality , Carcinoma, Squamous Cell/mortality , Esophageal Neoplasms/mortality , Esophagoscopy , Female , Humans , Male , Middle Aged , Retrospective Studies , Survival Rate , Treatment OutcomeABSTRACT
Traumatic spinal cord injury (TSCI) can cause paralysis and permanent disability. Rehabilitation (RB) is currently the only accepted treatment, although its beneficial effect is limited. The development of biomaterials has provided therapeutic possibilities for TSCI, where our research group previously showed that the plasma-synthesized polypyrrole/iodine (PPy/I), a biopolymer with different physicochemical characteristics than those of the PPy synthesized by conventional methods, promotes recovery of motor function after TSCI. The present study evaluated if the plasma-synthesized PPy/I applied in combination with RB could increase its beneficial effects and the mechanisms involved. Adult rats with TSCI were divided into no treatment (control); biopolymer (PPy/I); mixed RB by swimming and enriched environment (SW/EE); and combined treatment (PPy/I + SW/EE) groups. Eight weeks after TSCI, the general health of the animals that received any of the treatments was better than the control animals. Functional recovery evaluated by two scales was better and was achieved in less time with the PPy/I + SW/EE combination. All treatments significantly increased ßIII-tubulin (nerve plasticity) expression, but only PPy/I increased GAP-43 (nerve regeneration) and MBP (myelination) expression when were analyzed by immunohistochemistry. The expression of GFAP (glial scar) decreased in treated groups when determined by histochemistry, while morphometric analysis showed that tissue was better preserved when PPy/I and PPy/I + SW/EE were administered. The application of PPy/I + SW/EE, promotes the preservation of nervous tissue, and the expression of molecules related to plasticity as ßIII-tubulin, reduces the glial scar, improves general health and allows the recovery of motor function after TSCI. The implant of the biomaterial polypyrrole/iodine (PPy/I) synthesized by plasma (an unconventional synthesis method), in combination with a mixed rehabilitation scheme with swimming and enriched environment applied after a traumatic spinal cord injury, promotes expression of GAP-43 and ßIII-tubulin (molecules related to plasticity and nerve regeneration) and reduces the expression of GFAP (molecule related to the formation of the glial scar). Both effects together allow the formation of nerve fibers, the reconnection of the spinal cord in the area of injury and the recovery of lost motor function. The figure shows the colocalization (yellow) of ßIII-tubilin (red) and GAP-43 (green) in fibers crossing the epicenter of the injury (arrowheads) that reconnect the rostral and caudal ends of the injured spinal cord and allowed recovery of motor function.
Subject(s)
Biocompatible Materials , Exercise Therapy/methods , Iodine/chemistry , Polymers/chemistry , Pyrroles/chemistry , Spinal Cord Injuries/rehabilitation , Spinal Cord Injuries/surgery , Animals , Argon Plasma Coagulation/methods , Biocompatible Materials/administration & dosage , Biocompatible Materials/chemical synthesis , Biocompatible Materials/chemistry , Biocompatible Materials/radiation effects , Chemical Precipitation/radiation effects , Combined Modality Therapy , Disease Models, Animal , Environment Design , Female , Injections, Spinal , Iodine/administration & dosage , Iodine/radiation effects , Laminectomy , Lasers, Gas/therapeutic use , Motor Activity/drug effects , Motor Activity/physiology , Nerve Regeneration/drug effects , Nerve Regeneration/physiology , Polymers/administration & dosage , Polymers/chemical synthesis , Polymers/radiation effects , Pyrroles/administration & dosage , Pyrroles/chemical synthesis , Pyrroles/radiation effects , Rats , Rats, Long-Evans , Recovery of Function/drug effects , Recovery of Function/physiology , Spinal Cord Injuries/pathology , Spinal Cord Regeneration/drug effects , SwimmingABSTRACT
Radiofrequency ablation (RFA) is very effective for eradication of flat Barrett's mucosa in dysplastic Barrett's esophagus after endoscopic resection of raised lesions. However, in a minority of the time, RFA may be ineffective at eradication of the Barrett's mucosa. Achieving complete eradication of intestinal metaplasia can be challenging in these patients. This review article focuses on the management of patients with dysplastic Barrett's esophagus refractory to RFA therapy. Management strategies discussed in this review include optimizing the RFA procedure, optimizing acid suppression (with medical, endoscopic, and surgical management), cryotherapy, hybrid argon plasma coagulation, and EndoRotor resection.
Subject(s)
Barrett Esophagus/therapy , Esophageal Neoplasms/prevention & control , Esophagoscopy/methods , Esophagus/pathology , Gastroesophageal Reflux/therapy , Antacids/therapeutic use , Argon Plasma Coagulation/methods , Barrett Esophagus/etiology , Barrett Esophagus/pathology , Combined Modality Therapy/methods , Cryosurgery/methods , Esophagoscopy/instrumentation , Esophagus/diagnostic imaging , Esophagus/surgery , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/pathology , Humans , Radiofrequency Ablation/methods , Treatment OutcomeSubject(s)
Carcinoma, Adenoid Cystic/therapy , Combined Modality Therapy/methods , Tracheal Neoplasms/pathology , Aftercare , Aged , Argon Plasma Coagulation/methods , Bronchoscopy/methods , Carcinoma, Adenoid Cystic/diagnostic imaging , Cryotherapy/methods , Humans , Male , Positron Emission Tomography Computed Tomography/methods , Treatment OutcomeABSTRACT
Objective: This economic evaluation aims to provide a preliminary assessment of the cost-effectiveness of radiofrequency ablation (RFA) compared with argon plasma coagulation (APC) when used to treat APC-refractory gastric antral vascular ectasia (GAVE) in symptomatic patients.Methods: A Markov model was constructed to undertake a cost-utility analysis for adults with persistent symptoms secondary to GAVE refractory to first line endoscopic therapy. The economic evaluation was conducted from a UK NHS and personal social services (PSS) perspective, with a 20-year time horizon, comparing RFA with APC. Patients transfer between health states defined by haemoglobin level. The clinical effectiveness data were sourced from expert opinion, resource use and costs were reflective of the UK NHS and benefits were quantified using Quality Adjusted Life Years (QALYs) with utility weights taken from the literature. The primary output was the Incremental Cost-Effectiveness Ratio (ICER), expressed as cost per QALY gained.Results: Over a lifetime time horizon, the base case ICER was £4840 per QALY gained with an 82.2% chance that RFA was cost-effective at a threshold of £20,000 per QALY gained. The model estimated that implementing RFA would result in reductions in the need for intravenous iron, endoscopic intervention and requirement for blood transfusions by 27.1%, 32.3% and 36.5% respectively. Compared to APC, RFA was associated with an estimated 36.7% fewer procedures.Conclusions: RFA treatment is likely to be cost-effective for patients with ongoing symptoms following failure of first line therapy with APC and could lead to substantive reductions in health care resource.
Subject(s)
Argon Plasma Coagulation/methods , Cost-Benefit Analysis , Gastric Antral Vascular Ectasia/surgery , Radiofrequency Ablation/methods , Argon Plasma Coagulation/economics , Humans , Markov Chains , Quality-Adjusted Life Years , Radiofrequency Ablation/economicsABSTRACT
BACKGROUND: Patients after esophagectomy for esophageal squamous cell carcinoma (SCC) occasionally develop metachronous SCC in the residual esophagus. Although most of these second primary lesions are detected as superficial cancer at follow-up endoscopy, it is often difficult to perform endoscopic resection for these lesions near the site of anastomosis. METHODS: The objective of this study was to evaluate the effectiveness of argon plasma coagulation (APC) for superficial SCC in the residual esophagus after esophagectomy. Twelve patients (involving 15 s primary lesions) received APC for superficial SCC in the residual esophagus after esophagectomy. These lesions were difficult to perform endoscopic resection and they were treated using APC. RESULTS: There was no treatment-related complication. Complete remission (CR) was achieved in 13 (86.6%) of the 15 lesions: CR was achieved in 11 lesions (73.3%) after the first APC course, and in another 2 lesions (13.3%) after two or more APC courses. Of the 2 patients with persisting residual tumor, 1 patient received 12 times repeated-APC courses over 6 years, and eventually achieved local control without metastasis, the other patient received radiotherapy and cervical esophagectomy after treatment failure with APC. All patients survived except for one patient who died of old age and another patient who died of tongue cancer. CONCLUSIONS: APC was a safe treatment that was easy to perform. APC was concluded to be an effective treatment for superficial SCC in the residual esophagus after esophagectomy when endoscopic resection was difficult.
Subject(s)
Argon Plasma Coagulation/methods , Esophageal Squamous Cell Carcinoma/surgery , Esophageal Squamous Cell Carcinoma/therapy , Esophagectomy/adverse effects , Neoplasm, Residual/therapy , Neoplasms, Second Primary/therapy , Aged , Anastomosis, Surgical/adverse effects , Endoscopy/methods , Esophageal Neoplasms/pathology , Esophageal Squamous Cell Carcinoma/diagnosis , Esophagectomy/methods , Follow-Up Studies , Humans , Male , Middle Aged , Neoplasm, Residual/epidemiology , Neoplasms, Second Primary/epidemiology , Neoplasms, Second Primary/pathology , Treatment OutcomeABSTRACT
BACKGROUND: Tracheobronchoplasty is the definitive treatment for patients with symptomatic excessive central airway collapse. This procedure is associated with high morbidity and mortality rates. Bronchoscopic techniques are an appealing alternative with less morbidity and the ability to apply it in nonsurgical patients. Although thermoablative methods have been proposed as treatment options to induce fibrosis of the posterior tracheobronchial wall, no studies have compared direct histologic effects of such methods. This study compared the effects of electrocautery, radiofrequency ablation, potassium titanyl phosphate laser, and argon plasma coagulation (APC) in the tracheobronchial tree in an ex vivo animal model. METHODS: Four adult sheep cadavers were used for this study. Under flexible bronchoscopy, the posterior tracheal membrane was treated using different power settings on 4 devices. The airways were assessed for the presence of treatment-related histopathologic changes. RESULTS: Histologic changes observed were that of acute thermal injury including: surface epithelium ablation, collagen fiber condensation, smooth muscle cytoplasm condensation, and chondrocyte pyknosis. No distinct histologic differences in the treated areas among different modalities and treatment effects were observed. APC at higher power settings was the only modality that produced consistent and homogenous thermal injury effects across all tissue layers with no evidence of complete erosion. CONCLUSION: Although electrocautery, radiofrequency ablation, potassium titanyl phosphate laser, and APC all induce thermal injury of the airway wall, only APC at high power settings achieves this effect without complete tissue erosion, favoring potential regeneration and fibrosis. Live animal studies are now plausible.
Subject(s)
Airway Obstruction/therapy , Bronchi/pathology , Bronchoscopy/methods , Trachea/pathology , Airway Obstruction/etiology , Animals , Argon Plasma Coagulation/adverse effects , Argon Plasma Coagulation/methods , Bronchi/radiation effects , Electrocoagulation/adverse effects , Electrocoagulation/methods , Fibrosis/pathology , Lasers, Solid-State/adverse effects , Male , Models, Animal , Pilot Projects , Radiofrequency Ablation/adverse effects , Radiofrequency Ablation/methods , Sheep , Trachea/radiation effects , Tracheobronchomalacia/complicationsSubject(s)
Anemia, Iron-Deficiency , Antibodies, Antinuclear/blood , Cyclophosphamide/therapeutic use , Gastric Antral Vascular Ectasia , Gastrointestinal Hemorrhage , Gastroscopy/methods , Scleroderma, Systemic , Age Factors , Anemia, Iron-Deficiency/diagnosis , Anemia, Iron-Deficiency/etiology , Anemia, Iron-Deficiency/therapy , Antirheumatic Agents/therapeutic use , Argon Plasma Coagulation/methods , Argon Plasma Coagulation/statistics & numerical data , Brazil/epidemiology , Female , Gastric Antral Vascular Ectasia/epidemiology , Gastric Antral Vascular Ectasia/etiology , Gastric Antral Vascular Ectasia/immunology , Gastric Antral Vascular Ectasia/therapy , Gastrointestinal Hemorrhage/epidemiology , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy , Humans , Laser Therapy/methods , Laser Therapy/statistics & numerical data , Male , Middle Aged , Prevalence , Retrospective Studies , Scleroderma, Systemic/complications , Scleroderma, Systemic/physiopathology , Sex FactorsSubject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bone Neoplasms/surgery , Curettage/methods , Giant Cell Tumor of Bone/surgery , Anti-Infective Agents, Local/therapeutic use , Argon Plasma Coagulation/methods , Bone Cements/therapeutic use , Bone Neoplasms/drug therapy , Chemotherapy, Adjuvant , Cryosurgery/methods , Giant Cell Tumor of Bone/drug therapy , Humans , Neoplasm Recurrence, Local , Phenol/therapeutic use , Polymethyl Methacrylate/therapeutic use , Postoperative Complications/drug therapy , Postoperative Complications/etiologyABSTRACT
Central airway obstruction (CAO) is associated with significant morbidity and increased mortality. Bronchoscopic electrosurgical and laser ablative tools have proven to be safe and effective instruments for the treatment of malignant CAO. Although therapeutic modalities such as electrocautery, argon plasma coagulation, and laser have been used for decades, additional tools including radiofrequency ablation catheters continue to be developed for the treatment of CAO. These modalities are considered safe in the hands of experienced operators, although serious complications can occur. This review describes various electrosurgical and laser therapy tools used for the treatment of malignant CAO along with the specific advantages and disadvantages of each device.
Subject(s)
Airway Obstruction/surgery , Argon Plasma Coagulation/methods , Bronchoscopy , Catheter Ablation/methods , Electrosurgery/methods , Laser Therapy/methods , Respiratory Tract Neoplasms/surgery , Airway Obstruction/etiology , Argon Plasma Coagulation/adverse effects , Argon Plasma Coagulation/economics , Bronchi , Catheter Ablation/adverse effects , Catheter Ablation/economics , Electrocoagulation/adverse effects , Electrocoagulation/economics , Electrocoagulation/methods , Electrosurgery/adverse effects , Electrosurgery/economics , Humans , Laser Therapy/adverse effects , Laser Therapy/economics , Neoplasms/complications , Neoplasms/surgery , Respiratory Tract Neoplasms/complications , TracheaSubject(s)
Endoscopy/statistics & numerical data , Gastric Antral Vascular Ectasia/therapy , Gastrointestinal Hemorrhage/etiology , Pyloric Antrum/blood supply , Aged , Anemia, Iron-Deficiency/diagnosis , Anemia, Iron-Deficiency/etiology , Argon Plasma Coagulation/methods , Blood Transfusion/methods , Capsule Endoscopy/methods , Combined Modality Therapy , Diagnosis, Differential , Endoscopy/methods , Female , Gastric Antral Vascular Ectasia/diagnosis , Gastrointestinal Agents/therapeutic use , Gastrointestinal Hemorrhage/prevention & control , Humans , Liver Cirrhosis/diagnosis , Liver Cirrhosis/etiology , Octreotide/therapeutic use , Pyloric Antrum/pathology , Treatment OutcomeABSTRACT
Introducción: la proctitis actínica hemorrágica aparece secundaria a la radioterapia. El argón plasma resulta ser una técnica eficaz, segura, de fácil uso y relativo bajo costo. Objetivos: describir la respuesta terapéutica a corto y largo plazo del argón plasma en pacientes con proctitis actínica hemorrágica. Método: estudio observacional, prospectivo de serie de casos, en 82 pacientes con proctitis actínica hemorrágica, atendidos en el Centro Nacional de Cirugía de Mínimo Acceso entre 2010 y 2016. Se emplearon medidas de resumen y comparación de medias (t de Student pareada) para la hemoglobina final e inicial y se determinó el tiempo libre de resangrado, así como las complicaciones. Resultados: el 54,9% necesitó 1-3 sesiones de argón y el 86,6%, 1-5 sesiones para la resolución del sangrado, con una mediana de 3,0. El 4,9% de los enfermos presentó proctalgia como complicación. Existió mejoría de la hemoglobina de 2 g/dl. El resangrado ocurrió en el 8,5% de los pacientes en los nueve meses posteriores a la terapéutica. El tiempo libre de resangrado a los tres, seis y nueve meses fue del 98,8%, 96,3% y 91,5%, respectivamente. La respuesta terapéutica a corto plazo se observó en el 100% de los pacientes y a largo plazo, al año de seguimiento en el 91,5%. Conclusiones: el argón plasma tiene buena respuesta terapéutica a corto y largo plazo con pocas sesiones y bajo número de complicaciones en pacientes con proctitis actínica hemorrágica
Introduction: hemorrhagic radiation proctitis appears secondary to radiotherapy. Argon plasma is an effective, safe and easy-to-use technique with a relatively low cost. Objectives: to describe the short- and long-term response to argon plasma therapy in patients with hemorrhagic radiation proctitis. Method: an observational prospective study was performed of a series of 82 patients with hemorrhagic radiation proctitis, attended at the National Center for Minimally Invasive Surgery between 2010 and 2016. Summary measurements and a comparison of means (paired Student's t-test) for the final and initial hemoglobin levels were used. In addition, the Kaplan-Meier method was used to determine the rectal bleeding recurrence free time. Results: in the present study, 54.9% of cases required 1-3 argon sessions and 86.6% required 1-5 sessions to resolve the bleeding, with a median of 3.0 sessions. In addition, 4.9% of patients had proctalgia as a complication. There was an improvement in hemoglobin of 2 g/dl. Rectal bleeding recurrence occurred in 8.5% of the patients during the nine months after therapy. Bleeding recurrence free time at three, six and nine months was 98.8%, 96.3% and 91.5%, respectively. Short-term therapy response was observed in all patients and long-term response after one year of follow-up was 91.5%. Conclusion: argon plasma coagulation shows a good short- and long-term response with few therapy sessions and a low rate of complications in patients with chronic hemorrhagic radiation proctitis
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Proctitis/therapy , Gastrointestinal Hemorrhage/therapy , Radiation Injuries/therapy , Argon Plasma Coagulation/methods , Radiotherapy/adverse effects , Prospective Studies , Chronic Pain/epidemiology , Argon Plasma Coagulation/adverse effects , Treatment Outcome , Time FactorsABSTRACT
BACKGROUND: This study aimed to study the clinical efficacy of argon plasma coagulation plus cryotherapy for central airway stenosis caused by lung cancer. METHODS: The clinical data of 177 patients with central airway stenosis caused by lung cancer received surgery from June, 2017 to July 2018 were retrospectively analyzed. According to different treatments, 43 patients received cryotherapy were included in the control group, while 134 patients received argon plasma coagulation plus cryotherapy were in the observation group. After propensity score matching, patients in the two groups were in a 1:1 ratio. The Karnofsky score, partial pressure of oxygen (PaO2), arterial oxygen saturation (SaO2), partial pressure of arterial carbon dioxide (PaCO2) and adverse reactions in patients were analyzed one week before and after treatment. Besides, the survival rates of the two groups were compared. RESULTS: After propensity score matching, the baseline data were not significantly different between the two groups. The post-treatment Karnofsky scores in the two groups were significantly higher than those of before treatment, and the post-treatment score of the observation group was higher than that of the control group (all P < 0.05). The post-treatment PaO2 and SaO2 in the observation group were both higher than those of the control group; while the PaCO2 in the observation group was significantly lower than that of the control group (all P < 0.05). In the observation group, the levels of PaO2 and SaO2 were significantly higher, and the level of PaCO2 was significantly lower after treatment than those of before treatment (all P < 0.05). The rates of completely effective and mild effective in the observation group were significantly higher than those in the control group (both P < 0.05). The incidences of bleeding, arrhythmia and fever in the observation group were significantly lower than those in the control group (all P < 0.05). The survival rate was significantly higher in the observation group (72.09%) than in the control group (51.16%). CONCLUSIONS: Argon plasma coagulation combined with cryotherapy can significantly alleviate the central airway stenosis caused by lung cancer, reduce the incidence of adverse reactions, and improve prognosis in patients.