The concept and pathological diagnostic criteria of gastric adenoma (dysplasia) differ between Western countries and Japan, and discrepancies between histopathological examinations before and after endoscopic resection may occur. Therefore, the natural history of adenoma should be interpreted and the treatment strategy of adenoma established. It is recommended that endoscopic resection be performed for high-grade dysplasia due to the potential higher risk of progression to carcinoma. For low-grade dysplasia, the risk of malignant transformation is relatively low. However, resection is considered the first approach for the purpose of diagnosis and treatment. If resection is not feasible, the alternative may be to use argon plasma coagulation for selected lesions that are less likely to be malignant. When Helicobacter pylori infection is detected, eradication therapy is recommended to reduce the risk of metachronous lesions. Post-resection follow-up should be performed within 1 year to detect synchronous lesions and then follow-up endoscopy at 1 or 2-year intervals may be considered for metachronous lesions.
Adenoma ; Argon Plasma Coagulation ; Diagnosis ; Endoscopy ; Follow-Up Studies ; Helicobacter pylori ; Japan ; Natural History ; Stomach

Gastric hemangioma in the neonatal period is a very rare cause of upper gastrointestinal bleeding. We present a case of hemangioma limited to the gastric cavity in a 10-day-old infant. A huge, erythematous mass with bleeding was observed on the lesser curvature side of the upper part of the stomach. Surgical resection was ruled out because the location of the lesion was too close to the gastroesophageal junction. Medical treatment with intravenous H₂ blockers, octreotide, packed red blood cell infusions, local epinephrine injection at the lesion site, application of hemoclip, and gel-form embolization of the left gastric artery did not significantly alter the transfusion requirement. Hemostasis was achieved with endoscopic argon plasma coagulation (APC). After two sessions of APC, complete removal of the lesion was achieved. APC was a simple, safe and effective tool for hemostasis and the ablation of gastric hemangioma without significant complications.
Argon Plasma Coagulation* ; Argon* ; Arteries ; Epinephrine ; Erythrocytes ; Esophagogastric Junction ; Hemangioma* ; Hemorrhage ; Hemostasis ; Humans ; Infant ; Infant, Newborn* ; Octreotide ; Stomach

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

Intraductal papillary mucinous neoplasm of the bile duct (IPMN-B) is frequently found and has recently been recognized as a precancerous lesion leading to invasive carcinoma characterized by papillary growth of the ductal epithelium with rich mucin production and cystic dilatation of the hepatic duct. Surgical resection is the treatment of choice to avoid malignant transformation. Despite a growing number of studies on IPMN-B, there are few reports of its treatment aside from surgery. A 75-year-old woman was incidentally diagnosed as IPMN-B. Considering the patient's age, comorbidity, and preference, we recommended an argon plasma coagulation (APC) as local ablation therapy rather than surgical resection. There was no evidence of remnant tumor on percutaneous transhepatic cholangioscopy 4 weeks after the ablation of tumor mass by using APC. We report a rare case of IPMN-B successfully treated with APC.
Aged ; Argon Plasma Coagulation* ; Argon* ; Bile Duct Neoplasms ; Bile Ducts* ; Bile* ; Comorbidity ; Dilatation ; Epithelium ; Female ; Hepatic Duct, Common ; Humans ; Mucins*

Intraductal papillary mucinous neoplasm of the bile duct (IPMN-B) is frequently found and has recently been recognized as a precancerous lesion leading to invasive carcinoma characterized by papillary growth of the ductal epithelium with rich mucin production and cystic dilatation of the hepatic duct. Surgical resection is the treatment of choice to avoid malignant transformation. Despite a growing number of studies on IPMN-B, there are few reports of its treatment aside from surgery. A 75-year-old woman was incidentally diagnosed as IPMN-B. Considering the patient's age, comorbidity, and preference, we recommended an argon plasma coagulation (APC) as local ablation therapy rather than surgical resection. There was no evidence of remnant tumor on percutaneous transhepatic cholangioscopy 4 weeks after the ablation of tumor mass by using APC. We report a rare case of IPMN-B successfully treated with APC.
Aged ; Argon Plasma Coagulation* ; Argon* ; Bile Duct Neoplasms ; Bile Ducts* ; Bile* ; Comorbidity ; Dilatation ; Epithelium ; Female ; Hepatic Duct, Common ; Humans ; Mucins*

BACKGROUND/AIMS: Colonoscopy can detect precancerous lesions, which can subsequently be removed and reduce incidences of and mortality from colorectal cancer (CRC). However, recently published data have highlighted a significant rate of CRC in patients who previously underwent colonoscopy. Among many reasons, incomplete resection has been considered as a significant contributor. However, to date, there have only been a few studies regarding incompletely resected polyps, especially advanced colorectal adenoma (ACA). Hence, we aimed to evaluate the prognosis of incompletely resected ACA. METHODS: We retrospectively reviewed the medical records of patients with ACA who had underwent endoscopic treatment with incomplete resection. The primary outcomes were (1) the incomplete resection rate of ACA, as determined by a histopathologic examination and (2) the recurrence rate of incompletely resected ACA. We also investigated the probable contributing factors that may have led to a relapse of incompletely resected ACA. RESULTS: A total of 7,105 patients had their colorectal polyps resected by endoscopic treatment, and 2,233 of these were considered as ACA. Of these, 354 polyps (15.8%) were resected incompletely, and only 163 patients were followed-up. Of those followed-up, 31 patients (19.0%) experienced local recurrence. The risk factors for recurrence after incomplete resection were evaluated; age, morphology of adenoma, and use of rescue therapy, such as argon plasma coagulation, were found to be associated with adenoma recurrence. CONCLUSIONS: Incompletely resected ACA in older patients or in patients with sessile-type adenomas should be monitored strictly, and if incomplete resection is suspected, rescue therapy must be considered.
Adenoma* ; Argon Plasma Coagulation ; Colonic Polyps ; Colonoscopy ; Colorectal Neoplasms ; Humans ; Incidence ; Medical Records ; Mortality ; Polyps ; Prognosis ; Recurrence* ; Retrospective Studies* ; Risk Factors*

Phlegmonous gastritis is a rare and rapidly progressive bacterial infection of the stomach wall, with a high mortality rate. Antibiotics with or without surgical treatment are required for treatment. We present a case in which phlegmonous gastritis occurred during the diagnostic evaluation of early gastric cancer. The patient showed improvement after antibiotic treatment, but attempted endoscopic submucosal dissection failed because of submucosal pus. We immediately applied argon plasma coagulation since surgical resection was also considered a high-risk procedure because of the submucosal pus and multiple comorbidities. However, there was local recurrence two years later, and the patient underwent subtotal gastrectomy with lymph node dissection. Considering the risk of incomplete treatment immediately after recovery from phlegmonous gastritis and that recurrent disease can be more difficult to manage, delaying treatment and evaluation until after complete recovery of PG might be a better option in this particular clinical situation.
Anti-Bacterial Agents ; Argon Plasma Coagulation ; Bacterial Infections ; Cellulitis* ; Comorbidity ; Gastrectomy ; Gastritis* ; Humans ; Lymph Node Excision ; Mortality ; Recurrence ; Stomach ; Stomach Neoplasms* ; Suppuration

BACKGROUND/AIMS: The clinicopathologic features of gastric cancer in young patients are different from those of older patients. However, endoscopic submucosal dissection (ESD) is performed regardless of age. The purpose of this study was to characterize younger patients (≤40 years) who underwent ESD for early gastric cancer (EGC) and analyze the results of ESD. MATERIALS AND METHODS: From January 2006 to June 2014, 55 patients aged 40 years or younger with newly diagnosed EGC underwent ESD at two tertiary hospitals. The clinicopathologic features of EGC and clinical outcomes of ESD in these young patients were reviewed retrospectively. RESULTS: A total 55 patients with 57 EGC lesions underwent ESD. Female sex, superficial flat or depressed lesions, and undifferentiated histology were more common in younger patients than in older patients in our institutional ESD cohort. The en bloc resection rate was 92.7% and the complete resection rate was 94.5%. Although there was a high proportion of undifferentiated cancer in the younger patient group, the curative resection rate was 72.7%. Among 15 patients with non-curative resection, 4 patients underwent additional surgery and 1 patient underwent argon plasma coagulation at the ESD ulcer margin. Eight patients were placed under close surveillance without additional treatment, and no recurrent tumors developed, with a median follow-up period of 37.2±23.6 months. CONCLUSIONS: Younger EGC patients who underwent ESD showed the typical characteristics seen in younger patients with gastric cancer. ESD in younger EGC patients showed comparable outcomes to those in patients with undifferentiated EGC in general.
Argon Plasma Coagulation ; Cohort Studies ; Female ; Follow-Up Studies ; Humans ; Retrospective Studies ; Stomach Neoplasms* ; Tertiary Care Centers ; Ulcer

Endoscopic resection of early gastric cancer is defined as incomplete when tumor cells are found at the resection margin upon histopathological examination. However, a tumor-positive resection margin does not always indicate residual tumor; it can also be caused by tissue contraction during fixation, by the cautery effect during endoscopic resection, or by incorrect histopathological mapping. Cases of highly suspicious residual tumor require additional endoscopic or surgical resection. For inoperable patients, argon plasma coagulation can be used as an alternative endoscopic treatment. Immediately after the incomplete resection or residual tumor has been confirmed by the pathologist, clinicians should also decide upon any additional treatment to be carried out during the follow-up period.
Argon Plasma Coagulation ; Cautery ; Follow-Up Studies ; Humans ; Neoplasm, Residual ; Stomach Neoplasms*

Non-variceal upper gastrointestinal bleeding, the most common etiology of which is peptic ulcer disease, remains a persistent challenge despite a reduction in both its incidence and mortality. Both pharmacologic and endoscopic techniques have been developed to achieve hemostasis, with varying degrees of success. Among the pharmacologic therapies, proton pump inhibitors remain the mainstay of treatment, as they reduce the risk of rebleeding and requirement for recurrent endoscopic evaluation. Tranexamic acid, a derivative of the amino acid lysine, is an antifibrinolytic agent whose role requires further investigation before application. Endoscopically delivered pharmacotherapy, including Hemospray (Cook Medical), EndoClot (EndoClot Plus Inc.), and Ankaferd Blood Stopper (Ankaferd Health Products), in addition to standard epinephrine, show promise in this regard, although their mechanisms of action require further investigation. Non-pharmacologic endoscopic techniques use one of the following two methods to achieve hemostasis: ablation or mechanical tamponade, which may involve using endoscopic clips, cautery, argon plasma coagulation, over-the-scope clipping devices, radiofrequency ablation, and cryotherapy. This review aimed to highlight these novel and fundamental hemostatic strategies and the research supporting their efficacy.
Argon Plasma Coagulation ; Catheter Ablation ; Cautery ; Cryotherapy ; Drug Therapy ; Embolization, Therapeutic ; Endoscopy ; Epinephrine ; Gastrointestinal Hemorrhage ; Hemorrhage* ; Hemostasis ; Incidence ; Lysine ; Mortality ; Peptic Ulcer ; Proton Therapy ; Tranexamic Acid