The initial experience of safety and efficacy of argon plasma coagulation (APC)
- Citation:
- Hamza, I., M. Mahmoud, and S. Labib, The initial experience of safety and efficacy of argon plasma coagulation (APC), , 2012.
Abstract:
Background and study aims: The well-known complications of variceal bleeding together with the high
mortality rate mandate effective prophylaxis. Because of the intolerance, failure of response and lack
of compliance related to B blockers and because of the high incidence of variceal recurrence after endoscopic
variceal ligation (EVL), other alternatives should be investigated. As APC provides coagulation at a
shallow depth, it has been considered an ideal procedure to promote mucosal fibrosis for oesophageal
varices. This study aims to investigate the safety and effectiveness of APC application to the oesophagus
post-variceal obliteration in an attempt to decrease variceal recurrence and bleeding, as compared to EVL.
Patients and methods: This study included 60 patients with chronic liver disease and portal hypertension
referred to the Gastrointestinal Endoscopy Unit, Kasr Al-Aini Hospital, Cairo University, during the period
from August 2008 till January 2010. Patients had to have large-sized varices (F3), without history of
bleeding, portal hypotensive drugs or intervention.
Patients were allocated into either group I that included 30 patients for whom EVL was performed and
sequentially followed by one session of APC or group II that included 30 patients for whom EVL alone was
done. Patients underwent surveillance endoscopy at 3 and 6 months to evaluate variceal recurrence (F1
or more).
Results: Both groups were comparable in terms of the demographic features, hepatic functional reserve
and endoscopic findings. Post-APC, fever was reported in 6.7%, dysphagia in 3.3%, procedure-related
bleeding in 0% and stricture in 3.3%. At 3 and 6 months follow-up, both groups were comparable in terms
of variceal recurrence and none of the patients in both groups developed variceal bleeding.
Conclusion: Although, APC application to the oesophageal mucosa is a safe technique, its additive benefit
in terms of variceal recurrence and re-bleeding is comparable to EVL alone. This is encountered when
only a single session of APC is applied. A more beneficial effect of multiple sessions of APC awaits further
studies.