1.The Clinical Significance and Management of Noncurative Endoscopic Resection in Early Gastric Cancer.
Clinical Endoscopy 2013;46(3):235-238
Nowadays, endoscopic mucosal resection or endoscopic submucosal dissection has shown effectiveness equivalent to that of gastrectomy and has emerged as a popular technique for curative treatment of gastric cancer. However, noncurative resection or resection beyond the indication may lead to lymphatic and extended organ metastasis resulting in loss of the opportunity for full recovery. Therefore, it is an important issue to decide the range of curative resection in the endoscopic resection field. Furthermore, management of noncurative endoscopic resection in early gastric cancer is also important. The most favorable treatment after noncurative resection would be surgery. However, other noninvasive treatments such as argon plasma coagulation, additional endoscopic resection and close observation for recurrence are thought to be the optional treatments after the noncurative resection. In the future, prospective research studies and observations are expected to verify the effectiveness of noninvasive treatments.
Argon Plasma Coagulation
;
Gastrectomy
;
Neoplasm Metastasis
;
Recurrence
;
Stomach Neoplasms
2.Therapeutic Small Bowel Endoscopy in Practice.
Korean Journal of Gastrointestinal Endoscopy 2009;39(2):59-65
Since the first introduction of double balloon enteroscopy (DBE) in 2001, DBE has been refined for complete exploration of the small bowel and therapeutic interventions. Diagnostic DBE using a model EN-450P5 (Fujinon, Saitama, Japan) equipped with a small accessory channel is mainly used for endoscopic observation and limited therapeutic procedures including injection therapy, argon plasma coagulation and polypectomy. Therapeutic DBE utilizing a model EN-450T5 (Fujinon, Saitama, Japan) equipped with a larger accessory channel was developed for various endoscopic interventions. Recently, new enteroscopic techniques such as single balloon enteroscopy and spiral enteroscopy were introduced. These enteroscopic techniques are all used for the controlled observation, targeted tissue sampling for pathologic evaluation and various therapeutic interventions. The overall complication rate of DBE seems acceptable but that of therapeutic DBE is higher than diagnostic DBE and therapeutic colonoscopies because the small intestinal wall is much thinner than other intestinal wall. This review provides an overview concerning therapeutic interventions of DBE.
Argon Plasma Coagulation
;
Colonoscopy
;
Double-Balloon Enteroscopy
;
Endoscopy
;
Intestine, Small
3.Endoscopic Removal of a Proximally Migrated Metal Stent during Balloon Sweeping after Stent Trimming.
Nam Jun CHO ; Tae Hoon LEE ; Sang Heum PARK ; Han Min LEE ; Kyung Hee HYUN ; Suck Ho LEE ; Il Kwun CHUNG ; Sun Joo KIM
Clinical Endoscopy 2013;46(4):418-422
Placement of a self-expanding metal stent (SEMS) is an effective method for palliation of a malignant biliary obstruction. However, metal stents can cause various complications, including stent migration. Distally migrated metal stents, particularly covered SEMS, can be removed successfully in most cases. Stent trimming using argon plasma coagulation may be helpful in difficult cases despite conventional methods. However, no serious complications related to the trimming or remnant stent removal method have been reported due to the limited number of cases. In particular, proximal migration of a remnant fragmented metal stent after stent trimming followed by balloon sweeping has not been reported. We report an unusual case of proximal migration of a remnant metal stent during balloon sweeping following stent trimming by argon plasma coagulation. The remnant metal stent was successfully removed with rotation technique using a basket and revised endoscopically.
Argon Plasma Coagulation
;
Cholangiopancreatography, Endoscopic Retrograde
;
Pancreatic Neoplasms
;
Stents
4.A Case of Huge Gastric Angiodysplasia Treated with Argon Plasma Coagulation.
Sung Jin MOON ; Jin Il KIM ; Jae Kyu CHUNG ; Min Kuk KIM ; Dae Young CHEUNG ; Se Hyun CHO ; Soo Heon PARK ; Joon Yeol HAN ; Jae Kwang KIM ; Kyu Yong CHOI
Korean Journal of Gastrointestinal Endoscopy 2006;33(5):289-293
Gastric angiodysplasia is an uncommon cause of upper gastrointestinal blood loss that may occur in the stomach or duodenum, and is responsible for up to 1~6% of upper gastrointestinal bleeding. In contrast to colonic angioectasia, gastric lesions are more common in young individuals and originate from developmental causes. On an endoscopic examination, the lesions typically show a spider-shape or coral reef-like pattern of dilated and tortuous vessels and measure approximately 2 to 10 mm in diameter. We encountered a case of huge gastric angiodysplasia that presented with overt bleeding and anemia and was successfully treated with argon plasma coagulation.
Anemia
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Angiodysplasia*
;
Anthozoa
;
Argon Plasma Coagulation*
;
Argon*
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Colon
;
Duodenum
;
Hemorrhage
;
Stomach
5.Submucosal Injection of Normal Saline can Prevent Unexpected Deep Thermal Injury of Argon Plasma Coagulation in the in vivo Porcine Stomach.
Mitsuhiro FUJISHIRO ; Shinya KODASHIMA ; Satoshi ONO ; Osamu GOTO ; Nobutake YAMAMICHI ; Naohisa YAHAGI ; Koji KASHIMURA ; Toyokazu MATSUURA ; Mikitaka IGUCHI ; Masashi OKA ; Masao ICHINOSE ; Masao OMATA
Gut and Liver 2008;2(2):95-98
BACKGROUND/AIMS: There have been several reports of thermal injury induced by argon plasma coagulation (APC) in animal models, but no follow-up studies have revealed the actual thermal injury. METHODS: APC was performed on the stomachs of two living minipigs with and without prior submucosal injection of normal saline. The power and argon gas flow were set to 60 watts and 2 L/min, respectively, and pulse durations of 5, 10, and 20 seconds were used. One of the minipigs was killed immediately thereafter and the other was killed 1 week later. RESULTS: The minipig killed immediately showed only subtle differences between noninjected and injected injuries under all the conditions, and the usefulness of prior submucosal injection was not obvious. However, the minipig killed 1 week later had a deep ulcer extending to the deeper muscle layer at the noninjected site where APC had been applied for 20 seconds, whereas tissue injury of the injected site was limited to the submucosal layer. CONCLUSIONS: Unexpected tissue damage can occur even using a short-duration APC. Prior submucosal injection for APC might be a safer alternative technique, especially in a thinner and narrower gut wall.
Argon
;
Argon Plasma Coagulation
;
Models, Animal
;
Muscles
;
Stomach
;
Swine, Miniature
;
Ulcer
6.Synchronous Roentgenographically Occult Lung Carcinoma Treated with Argon Plasma Coagulation in a Patient with Resectable Primary Lung Cancer.
Mi Hye KWON ; Mi Il KANG ; Ji Hyun JEONG ; Hee Kwan WON ; Hyun Woong PARK ; Jung Ho PARK ; Sung Tae KIM ; Sun Jung KWON ; Eugene CHOI ; Moon Jun NA ; Hyun Min CHO ; Young Jin KIM ; Yoon Mee KIM ; Young Jun CHO ; Ji Woong SON
Tuberculosis and Respiratory Diseases 2008;65(2):137-141
We treated synchronous double primary lung cancers, where one site resulted from CIS disease, with lobectomy and argon plasma coagulation (APC) in a patient who couldn't tolerate pneumonectomy, which resulted in a reduction of the extent of surgery. APC could be a reasonable alternative for CIS disease of lung in inoperable patients.
Argon
;
Argon Plasma Coagulation
;
Carcinoma in Situ
;
Humans
;
Lung
;
Lung Neoplasms
;
Pneumonectomy
7.A Case of Argon Plasma Coagulation Therapy for Hemorrhagic Radiation-induced Gastritis.
Mi Young JANG ; Yong Keun CHO ; Sung Jun GOH ; Min Gyu PARK ; Dong Yup LEE ; Yong Woo SEO ; Gum Mo JUNG ; Jin Woong CHO
Korean Journal of Gastrointestinal Endoscopy 2011;42(1):24-27
Hemorrhagic radiation-induced gastritis is a rare but serious complication of upper gastrointestinal radiation treatment, and no simple and effective treatment method has yet been developed. Studies on effective treatment methods for achieving hemostasis in patients with hemorrhagic radiation-induced gastritis are necessary, because the new indications for upper gastrointestinal radiotherapy in the field digestive oncology can potentially lead to an increased incidence of radiation-induced gastric vasculopathy. For the first time in Korea and to the best of our knowledge, we report here on a 59-years-old male patient with hemorrhagic gastritis that was induced by external radiotherapy for ampullary adenocarcinoma. This was all well-treated using Argon plasma coagulation (APC).
Adenocarcinoma
;
Argon
;
Argon Plasma Coagulation
;
Gastritis
;
Hemostasis
;
Humans
;
Incidence
;
Korea
;
Male
8.The Clinical Effect of Supplementary Argon Plasma Coagulation after Endoscopic Mucosal Piecemeal Resection of a Gastric Adenoma and Carcinoma.
Sang Joon PARK ; Kee Myung LEE ; Deok Ki KIM ; Sung Jae SIN ; Jae Ho JUNG ; Sung Hyeon JUNG ; Byeong Moo YOO ; Ki Baik HAHM ; Jin Hong KIM
Korean Journal of Gastrointestinal Endoscopy 2007;34(6):291-297
BACKGROUND/AIMS: This study was designed to determine the effect of supplementary argon plasma coagulation (APC) after piecemeal resection of a gastric adenoma or an intramucosal adenocarcinoma. METHODS: Cases of 62 lesions of 56 consecutive patients with either a gastric adenoma or carcinoma were retrospectively reviewed at the Ajou University Medical Center. APC was performed after an endoscopic complete resection using the piecemeal method of endoscopic mucosal resection (EMR) for patients in the EMR-APC group. For patients in the EMR group, APC was not performed. RESULTS: There was no significant difference in the recurrence rate of the cancers for both groups (9.7%, for the EMR group, 6.5% for the EMR-APC group). The recurrence rate of a low grade dysplasia was 6.7% (EMR group) and 6.3% (EMR-APC group) (p=1.000), the recurrence rate for a high grade dysplasia was 11.1% (EMR group) and 25.0% (EMR-APC group) (p=1.000), and the recurrence rate for an intramucosal adenocarcinoma was 14.3% (EMR group) and 0% (EMR-APC group) (p=0.389). The recurrence rates of lesions in which the lesion size was less than 20 mm and over 20 mm for each group were 6.7% and 9.1% (EMR group) (p=1.000) versus 12.5% and 0% (EMR-APC group) (p=0.520). There was also no significant statistical difference in the recurrence rates for both groups according to the location and macroscopic type of lesion. CONCLUSIONS: Supplementary treatment with APC could not significantly reduce the recurrence rate after complete piecemeal resection determined macroscopically. A large- scale and prospective study is necessary to elucidate the clinical significance of supplementary APC for gastric neoplasm treatment.
Academic Medical Centers
;
Adenocarcinoma
;
Adenoma*
;
Argon Plasma Coagulation*
;
Argon*
;
Humans
;
Recurrence
;
Retrospective Studies
;
Stomach Neoplasms
9.The Usefulness of Argon Plasma Coagulation Compared with Endoscopic Submucosal Dissection to Treat Gastric Adenoma.
Dong Hyun LEE ; Won Ki BAE ; Jong Wook KIM ; Woo Hyun PAIK ; Nam Hoon KIM ; Kyung Ah KIM ; June Sung LEE
The Korean Journal of Gastroenterology 2017;69(5):283-290
BACKGROUND/AIMS: To date, the best therapeutic modality for gastric adenoma, especially low-grade adenoma, has not been established. The aim of this study was to assess the usefulness of argon plasma coagulation (APC) in treating gastric adenoma compared with endoscopic submucosal dissection (ESD). METHODS: We included 210 patients with gastric adenoma, who underwent treatment with either APC (97 patients) or ESD (113 patients). The clinical and pathologic characteristics, mean duration of hospital stay, complications, and recurrence rates between the two groups were compared. RESULTS: The mean adenoma size was 0.9 cm and 1.1 cm in the APC group and ESD group, respectively (p<0.001). The mean duration of hospital stay was significantly shorter in the APC group than in the ESD group (1.6 days vs. 5.8 days, p<0.001). Complications did not occur in the APC group. However, one case of perforation (0.9%) and 6 cases of bleeding (5.3%) occurred in the ESD group. The recurrence rates were 15.3% (15/97 patients) in the APC group and 3.5% (4/113 patients) in the ESD group (p=0.003). The proportion of hospitalization was less in the APC group (43.3%, 42/97) than in the ESD group (100.0%, 113/113) (p<0.001). Medical expense was less in the APC group (377,172 won) than in the ESD group (1,430,610 won) (p<0.001). CONCLUSIONS: The findings of this study suggest that APC is a safe treatment method for gastric adenoma without serious complications. However, regular endoscopic follow-up is necessary to detect any residual or recurrent lesions due to the relatively high rate of local recurrence after APC.
Adenoma*
;
Argon Plasma Coagulation*
;
Argon*
;
Follow-Up Studies
;
Hemorrhage
;
Hospitalization
;
Humans
;
Length of Stay
;
Methods
;
Recurrence
10.Controlled Comparison of Endoscopic Epinephrine Injection and Endoscopic Argon Plasma Coagulation for the Treatment of Acute Peptic Ulcer Bleeding.
Kyung Im PAE ; Sang Hyuk LEE ; Hee KIM ; Sang Bong LEE ; Jae Ho LEE ; Sung Jae PARK ; Sam Ryong JEE ; Eun Taek PARK ; Yeon Jae LEE ; Sang Young SEOL ; Jung Myung CHUNG
Korean Journal of Gastrointestinal Endoscopy 2006;32(4):239-245
BACKGROUND/AIMS: Endoscopic injection therapy with hypertonic saline Epinephrine (HSE) is the easiest and most widely used procedure for the management of peptic ulcer bleeding. Argon plasma coagulation (APC) is a recently introduced endoscopic hemostatic procedure. Thus, we performed a prospective trial to compare the hemostatic efficacy of APC and HSE. METHODS: Forty patients with the diagnosis of bleeding ulcer were randomly assigned to receive either HSE (n=20) or APC (n=20) treatment during the period of September 2003 to April 2004. The two groups were matched for gender, age, site of bleeding, the endoscopic findings and the initial hemoglobin at the study baseline. RESULTS: The bleeding was initially controlled in 18 patients (90%) of the APC group, and in 20 patients (100%) of the HSE group. Rebeeding occurred in one patient (5%) of the APC group and in 3 patients (15.5%) of the HSE group. The lengths of stay in the hospital were 11.7 days in the APC group and 10.7 days in the HSE group. Death occurred in 1 case in the APC group and in 1 case in the HSE group. The initial hemostatic efficacy showed no difference between the two groups. CONCLUSIONS: Argon plasma coagulation is as effective as hypertonic saline epinephrine injection for the initial management of acute peptic ulcer bleeding.
Argon Plasma Coagulation*
;
Argon*
;
Diagnosis
;
Epinephrine*
;
Hemorrhage*
;
Humans
;
Peptic Ulcer*
;
Prospective Studies
;
Ulcer