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Acute bleeding after argon plasma coagulation for weight regain after gastric bypass: A case report

World Journal of Clinical Cases 2019年第15期7卷 2038-2043页

作者： Diogo Turiani Hourneaux de Moura Amit H Sachdev Po-Wen Lu Igor Braga Ribeiro Christopher C Thompson Division of Gastroenterology Hepatology and EndoscopyBrigham and Women’s HospitalHarvard Medical SchoolBostonMA 02115United States Department of Gastroenterology Clinics Hospital of Sao Paulo UniversitySao Paulo 05403-00Brazil Department of Gastroenterology and Hepatology Linkou Chang Gung Memorial HospitalTaoyuan City33305Taiwan

BACKGROUND Roux-en-Y gastric bypass(RYGB) is the most commonly performed surgical procedure used to treat obesity worldwide. Despite satisfactory results in terms of weight loss, over time many patients experience weight regain. There are many factors that contribute to weight regain after RYGB, including the diameter of the gastric-jejunal anastomosis(GJA). One of the most commonly performed endoscopic procedures for weight regain after RYGB is argon plasma coagulation(APC). We report a case of hematemesis after outlet revision with APC. We highlight several treatment modalities that can be used to treat this *** SUMMARY A 45-year-old female with a history of weight regain after RYGB was referred for possible endoscopic treatment for weight regain. On endoscopic evaluation, the diameter of the GJA was 22 mm. Due to the dilated GJA, treatment with APC was performed. Several months later she reported a return of poor satiety and an increased appetite. A repeat endoscopy was then performed. The GJA was approximately 15 mm and was incompetent. APC was performed. One day post procedure she had four episodes of hematemesis. An endoscopy was performed and a large ulcer with a visible arterial vessel was visualized at the *** was attempted using a Coagrasper and after initial contact with the vessel, the vessel started oozing. Due to fibrosis and the depth of ulceration in the area, clips and repeat APC could not be used. Therefore, an attempt to inject epinephrine injection was made. However, persistent oozing was noted. As a result, hemostatic powder was applied to the region of the bleeding ***, no more bleeding was observed. On follow-up, the patient remained hemodynamically stable and a second look endoscopy was not performed. The patient was discharged three days *** APC revision of the GJA is known to be a relatively safe and effective strategy to manage weight regain post RYGB. Anastomotic site bleeding is an i

关键词： Anastomosis Roux-en-Y argon plasma coagulation Bariatric Gastric bypass Gastrointestinal hemorrhage Case report

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Role of argon plasma coagulation in treatment of esophageal varices

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World Journal of Clinical Cases 2021年第3期9卷 521-527页

作者： Ying Song Yuan Feng Li-Hui Sun Bo-Jiang Zhang Hong-Juan Yao Jing-Gui Qiao Shu-Fen Zhang Ping Zhang Bin Liu Department of Gastroenterology Xi’an Gaoxin HospitalXi'an 710032Shaanxi ProvinceChina Department of Clinical Medical Affair Erbe China Ltd.Shanghai 200336China

With the development of endoscopic therapy,argon plasma coagulation(APC)has been widely used by *** has many advantages,such as simple to operate,low cost,and minimal *** of its capability of lesion ablation and hemostasis,APC has several indications in the gastrointestinal *** of them is esophageal *** aim of this review is to summarize the research on APC in this field to provide a reference for clinical practice.

关键词： Esophageal varices argon plasma coagulation Clinical practice Endoscopic therapy Gastrointestinal tract Minimally invasive

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Rectal ulcer:Due to ketoprofen, argon plasma coagulation and prostatic brachytherapy

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World Journal of Gastroenterology 2014年第45期20卷 17244-17246页

作者： Thibaud Koessler Vincent Servois Pascale Mariani Emilie Aubert Wulfran Cacheux Department of Oncology H?pitaux universitaires de Genève Department of Radiology Institut Curie75248 Paris France epartment of Surgical Oncology Institut Curie 75248 Paris France Department of Surgical Oncology Institut Curie 75248 Paris France

Prostatic brachytherapy with permanent seed implants is a recent and safe radiation therapy technique associated with radiation-induced digestive *** plasma coagulation procedure is a validated modality in the management of haemorrhagic radiation proctitis,which is known to occasionally induce chronic rectal *** report here an original case report of an acute painful rectal ulcer as a consequence of the combination of shortterm therapy with non-steroidal anti-inflammatory drugs therapy,prostatic brachytherapy with malposition of seed implants and argon plasma coagulation procedure in a patient with haemorrhagic radiation *** description of this clinical observation is essential to recommend the discontinuation of non-steroidal anti-inflammatory drugs therapy and the control of the position of seed implants in case of prostatic brachytherapy before argon plasma coagulation for radiation-induced proctitis.

关键词： Radiation proctitis Prostatic brachytherapy argon plasma coagulation Non-steroidal anti-inflammatory drugs

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Endoscopic ablation of Barrett's esophagus using high power setting argon plasma coagulation: A prospective study

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World Journal of Gastroenterology 2005年第12期11卷 1872-1875页

作者： Corrado Pedrazzani Filippo Catalano Mara Festini Germana Zerman Anna Tomezzoli Andrea Ruzzenente Alfredo Guglielmi Giovanni de Manzoni First Department of General Surgery

AIM: This prospective study evaluated the effectiveness of 90 W argon plasma coagulation (APC) for the ablation of Barrett's esophagus (BE) that is considered to be the main risk factor for the development of esophageal ***: The results from 25 patients, observed at the First Department of General Surgery, University of Verona, Italy, from October 2000 to October 2003, who underwent APC for histologically proven BE were prospectively ***: The ablation treatment was completed in all the patients but one (96%). The mean number of APC sessions needed to complete ablation was 1.6 (total number: 40). The eradication was obtained in the majority of cases by one session only (60%), two sessions were required in 24% of the cases and three or more in 16%.About 43% of the sessions were complicated. Retrosternal pain (22.5%) and fever (17.5%) were the most frequent symptoms. Only one major complication occurred, it was an hemorrhage due to ulcer formation on the treated esophagus that required urgent endoscopic sclerosis and admission. The follow-up was accomplished in all the patients with a mean period of 26.3 mo and 20 patients (84%) with a follow-up period longer than 24 mo. Only one patient showed a relapse of metaplastic mucosa 12 mo after the completion of ablation. The patient was hence re-treated and now is free from recurrence 33 mo ***: High power setting (90 W) APC showed to be safe and effective. The effects persist at a mean follow-up period of two years with a comparable cost in term of complications with respect to standard power settings. Further studies with greater number of patients are required to confirm these results and to assess if ablation reduces the incidence of malignant progression.

关键词： Barrett's esophagus argon plasma coagulation Endoscopic treatment

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Long-term follow-up after complete ablation of Barrett's esophagus with argon plasma coagulation

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World Journal of Gastroenterology 2005年第8期11卷 1182-1186页

作者： Ahmed Madisch Stephan Miehike Ekkehard Bayerdoerffer Birgit Wiedemann David Antos Anke Sievert Michael Vieth Manfred Stolte Heinrich Schulz Medical Department Ⅰ Department of Hematology and Oncology Institute of Medical Statistics and Biometry Clinic for Pediatric Diseases Gastroenterologist in private practice Institute of Pathology

AIM: To report the long-term outcome of patients after complete ablation of non-neoplastic Barrett's esophagus (BE) with respect to BE relapse and development of intraepithelial neoplasia or esophageal adenocarcinoma. METHODS: In 70 patients with historically proven non neoplastic BE, complete BE ablation was achieved by argon plasma coagulation (APC) and high-dose proton pump inhibitor therapy (120 mg omeprazole daily). Sixty-six patients (94.4%) underwent further surveillance endoscopy. At each surveillance endoscopy four-quadrant biopsies were taken from the neo-squamous epithelium at 2 cm intervals depending on the pre-treatment length of BE mucosa beginning at the neo-Z-line, and from any endoscopically suspicious lesion. RESULTS: The median follow-up of 66 patients was 51 mo (range 9-85 mo) giving a total of 280.5 patient years. A mean of 6 biopsies were taken during surveillance endoscopies. In 13 patients (19.7%) tongues or islands suspicious for BE were found during endoscopy. In 8 of these patients (12.1%) non-neoplastic BE relapse was confirmed histologically giving a histological relapse rate of 3% per year. In none of the patients, intraepithelial neoplasia nor an esophageal adenocarcinoma was detected. Logistic regression analysis identified endoscopic detection of islands or tongues as the only positive predictor of BE relapse (P= 0.0004). CONCLUSION: The long-term relapse rate of non neoplastic BE following complete ablation with high-power APC is low (3% per year).

关键词： Barrett's esophagus argon plasma coagulation Esophageal adenocarcinoma

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Endoscopic resolution and recurrence of gastric antral vascular ectasia after serial treatment with argon plasma coagulation

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World Journal of Gastrointestinal Endoscopy 2017年第6期9卷 263-266页

作者： Shashank Garg Bilal Aslam Nicholas Nickl Division of Digestive Diseases and Nutrition Department of MedicineUniversity of Kentucky Department of Medicine University of Kentucky

To evaluate long-term endoscopic resolution and recurrence rate of gastric antral vascular ectasia (GAVE) after argon plasma coagulation (APC) treatment. METHODSThis was an IRB-approved retrospective single center study that included patients endoscopically treated for GAVE between 1/1/2008 to 12/31/2014. The primary and secondary end points of the study were rate of endoscopic resolution of GAVE after APC treatment and recurrence rate of GAVE after endoscopic resolution, respectively. Endoscopic resolution of GAVE was defined as no endoscopic evidence of GAVE after treatment with APC. Recurrence of GAVE was defined as endoscopic reappearance of GAVE after prior resolution. RESULTSTwenty patients met the study criteria. Median age (range) of the patients was 59.5 years (42-74 years). GAVE was associated with underlying cirrhosis in 16 (80%) patients. Indications for initial esophagogastroduodenoscopy (EGD) included hematemesis and/or melena (9/20, 45%), iron deficiency anemia (6/20, 30%), screening or surveillance of varices (4/20, 20%), and occult gastrointestinal bleeding (1/20, 5%). The patients were treated with a total of 55 APC sessions (range 1-7 sessions). Successful endoscopic resolution of GAVE was achieved in 8 out of 20 patients (40%). There was no correlation between number of treatment sessions and GAVE treatment success (P = NS). Recurrence of GAVE was noted on a subsequent EGD in 2 out of 8 patients (25%) with prior endoscopic resolution of GAVE. Median follow-up period for the study population was 627 d (range 63-1953 d). CONCLUSIONEndoscopic resolution rate of GAVE was low (40%) with a 25% recurrence rate after treatment with APC. These rates suggest that APC treatment of GAVE may not be optimal in many circumstances.

关键词： Gastric antral vascular ectasia argon plasma coagulation

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Endoscopic ablation of Barrett's esophagus using the second generation argon plasma coagulation:a prospective randomized controlled trail

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Journal of Nanjing Medical University 2009年第3期23卷 183-188页

作者： Li Zhang Lei Dong Jia Liu Xiaolan Lu Jun Zhang Department of Digestive Disease the Second Affiliated Hospital Medical School of Xi' an Jiaotong University Xi' an 710004 China Department of Orthopedics the Second Affiliated Hospital Medical School of Xi' an Jiaotong University Xi' an 710004 China

Objective：To investigate the efficacy and safety of the second generation argon plasma coagulation（VIO APC） in the ablation of Barrett＇ s Esophagus. Methods：A total of 35 patients with uncomplicated Barrett＇ s esophagus entered into a prospective, randomized, unblinded study comparing the treatment VIO APC combined with a proton pump inhibiter with a proton pump inhibiter administered alone. VIO APC was performed at a power setting of 40W, and argon gas flow at 1.5-2.0 L/min, and＂ forced＂ mode. Ablative treatment was repeated until either no Barrett＇ s epithelium remained or a maximum of 5 treatment sessions occurred. Results：In the ablation group, macroscopic complete ablation was achieved in 14 of 18 patients, and complete ablation confirmed by histology in 12 of 18 patients （P 〈 0.01）. Buried glands were observed in 2 patients who had achieved macroscopic ablation. The Barrett＇s mucosa averaged a reduction of 65%（range 50-75%） in the remaining 4 patients. In the control group, only 2 patients had partial regression, median 30%（range 20-40%）. In the ablation group, post-treatment 4 patients had transient retrosternal pain, and 3 patients had mild epigastric discomfort. One patient had a small hemorrhage during the procedure, which ceased after norepinephrine and thrombosin were administered through the endoscope biopsy channel. No adverse events were observed in the control group. During 11.8（4-15） months follow-up, patients who had achieved the complete ablation have no evidence of relapse of Barrett＇ s esophagus. Conclusion：VIO APC with a relatively low power setting can effectively ablate the Barrett＇ s mucosa. No severe adverse events were observed. Long-term follow-up is needed to assess cancer prevention and the durability of the neo-squamous epithelium.

关键词： Barrett' s esophagus argon plasma coagulation efficacy safety

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Ablation of Barrett’s esophagus using the second-generation argon plasma coagulation

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Journal of Pharmaceutical Analysis 2009年第1期21卷 62-66页

作者： Li Zhang1, Lei Dong1, Jia Liu2, Xiao-lan Lu11. Department of Digestive Diseases, the Second Affiliated Hospital, Medical School of Xi’an Jiaotong University, Xi’an 710004 2. Department of Orthopedics, the Second Affiliated Hospital, Medical School of Xi’an Jiaotong University, Xi’an 710004, China. DepartmentofDigestiveDiseases theSecondAffiliatedHospitalMedicalSchoolofXi'anJiaotongUniversityXi'an710004 DepartmentofOrthopedics theSecondAffiliatedHospitalMedicalSchoolofXi'anJiaotongUniversityXi'an710004

Objective To investigate the efficacy and safety of the second-generation argon plasma coagulation (VIO APC) in ablation of Barrett’s esophagus. Methods Eighteen patients with Barrett’s esophagus (12 males, median age of 55 years, median length of 2.1 cm,1 low-grade dysplasia, 13 cases of short segment Barrett’s esophagus) received VIO APC, which was performed at a power setting of 40W and argon gas flow at 1.5-2.0 L/min, "forced" mode, in 1-3 sessions (mean 1.3). All the patients received treatment with high-dose proton pump inhibitors. The main complaints before ablation were upper abdominal pain in 12 patients (66%), sour regurgitation in 14 patients (77%), and dysphagia or odynophagia in 7 patients (38%). Two patients (11%) had esophageal hiatal hernia. Results The percentage of patients in whom ablation was endoscopically achieved proximal to the gastroesophageal junction was 77.8% (14/18), and histologically achieved in 66.7% (12/18). Berried glands were observed in 2 patients who had achieved endoscopic ablation, the areas of Barrett’s mucosa were reduced by more than 60% in the other 4 patients. After treatment, 4 patients had transient retrosternal pain and 3 patients had mild epigastric discomfort. One patient had small amounts of hemorrhage during the process, and it ceased after norepinephrine and thrombosin were administered through endoscope biopsy channel. No esophageal stricture or other severe adverse events was observed. During 11.8 (4-15) months’ follow-up, the patients who had achieved the complete ablation had no evidence of relapse of Barrett’s esophagus. Conclusion VIO APC with a relatively low power setting can effectively ablate the Barrett’s mucosa with special intestinal metaplasia when standard APC has been done. No severe adverse events were observed. Long-term follow-up is needed to assess cancer prevention and the durability of the neo-squamous epithelium.

关键词： Barrett’s esophagus argon plasma coagulation efficacy safety

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Efficacy and safety of argon plasma coagulation in the treatment of obstructive bronchostenosis

Efficacy and safety of argon plasma coagulation in the treat...

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第十七届中国内镜医师大会

作者： JIN Fa-guang MU De-guang CHU Dong-ling FU En-qing XIE Yong-hong LIU Tong-gang GU Xing (Department of Respiratory Disease,Tangdu Hospital,Fourth Military Medical University,Xian,Shaanxi 710038,P.R.China)

＜正＞【Objective】To evaluate the efficacy and safety of argon plasma coagulation in the treatment of airway obstruction.【Methods】Totally 389 patients with bronchostenosis were selected and treated with APC via bronchoscope,including 203 cases of carcinoma of trachea or bronchus,67 cases of metastatic tumor of trachea or bronchus,18 cases of benign tumor of trachea or bronchus,93 cases of granuloma and 8 cases of other *** recanalization,amendment of the symptoms, complications were evaluated.【Results】These 389 patients required 1121 times APC treatments. Full effectiveness was achieved in 138 cases（35.5%）,partial in 143 cases（36.8%）,mild in 55 cases （14.1%）and none in 53 cases（13.6%）.The main complications were as follows:sinus tachycardia in 136 cases（34.9%）,bleeding in 51 cases（13.1%）,decline of saturation of blood oxygen in 48 cases （12.3%）,asphyxia in 3 cases（8.5%）,ventricular or atrial arrhythmia in 24 cases（6.2%）,short-tern1 aggravation of airway obstruction in 18 cases（4.6%）,trachea perforation in 3 cases（0.78%）.All these complications were solved with different methods and no patients died during the procedure.【Re- sults】Bronchoscopic argon plasma coagulation was a effective and safe approach for the patients with airway obstruction.

关键词： bronchoscopy argon plasma coagulation airway obstructive stenosis

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Epinephrine plus argon plasma or heater probe coagulation in ulcer bleeding

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World Journal of Gastroenterology 2011年第36期17卷 4109-4112页

作者： Ahmet Karaman Mevlut Baskol Sebnem Gursoy Edip Torun Alper Yurci Banu Demet Ozel Kadri Guven Omer Ozbakir Mehmet Yucesoy Department of Gastroenterology Erciyes University38030 KayseriTurkey

AIM:To compare the effectiveness of argon plasma coagulation (APC) and heater probe coagulation (HPC) in non-variceal upper gastrointestinal ***:Eighty-five (18 female,67 male) patients admitted for acute gastrointestinal bleeding due to gastric or duodenal ulcer were included in the *** endoscopy was performed and HPC or APC were chosen randomly to stop the *** hemostasis and rebleeding rates were primary and secondary end-points of the ***:Initial hemostasis was achieved in 97.7% (42/43) and 81% (36/42) of the APC and HPC groups,respectively (P 0.05).CONCLUSION:APC is an effective hemostatic method in bleeding peptic *** multicenter trials are necessary to confirm these results.

关键词： Upper gastrointestinal bleeding argon plasma coagulation Heater probe coagulation Duodenal ulcer Gastric ulcer

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