Elsevier

Gastrointestinal Endoscopy

Volume 52, Issue 3, September 2000, Pages 342-345
Gastrointestinal Endoscopy

Original Articles
The tissue effect of argon plasma coagulation on esophageal and gastric mucosa,☆☆

Presented to the United European Gastroenterology Week, October 1997, Birmingham, United Kingdom, and published in abstract form (Endoscopy 1997;29:E19).
https://doi.org/10.1067/mge.2000.108412Get rights and content

Abstract

Background: Argon plasma coagulation is a diathermy-based non-contact therapeutic endoscopic modality that may have a lower risk of perforation than other tissue ablation techniques. Methods: Its effect was studied on three fresh esophageal and three fresh gastric resection specimens using power settings from 40 to 99 Watts at 90 degrees, with 1 mm separation using pulse durations of 1 and 3 seconds. A scoring system for depth of tissue damage was created and samples were analyzed blindly by a gastrointestinal histopathologist. Results: There was significantly greater damage to gastric tissue using a 3-second (compared with 1-second) pulse (p = 0.003) and marginally significantly greater damage to esophageal tissue using the 3-second pulse (p = 0.053). Tissue damage was related to power setting for gastric (p = 0.031) but not for esophageal tissue (p = 0.065). Only 1 of 42 esophageal samples and 2 of 42 gastric samples examined showed damage extending into the muscularis propria. Conclusions: Deep tissue damage that could lead to perforation was rare with argon plasma coagulation. The depth of gastric mucosal damage increased with increased pulse duration and increasing power settings, and, although the depth of esophageal mucosal damage was marginally related to pulse duration, it was not related to the power setting. (Gastrointest Endosc 2000;52:342–5).

Section snippets

Patients and methods

Samples of normal esophageal and gastric tissue were obtained from patients with esophageal or gastric cancer undergoing surgical resection. The samples of normal tissue were obtained from the margins of the resection specimens. Two patients with esophageal adenocarcinoma and one with esophageal squamous carcinoma each provided a single sample of normal esophageal tissue and three with gastric adenocarcinoma each provided a single sample of normal gastric tissue. The median age of the patients

Results

The macroscopic appearance of the tissue damage produced is shown in Figure 1.

. Photograph of macroscopic appearance of pulses of argon plasma coagulation on gastric mucosa.

The histologic effect consisted of coagulation necrosis that varied from superficial cell damage to wedge-shaped defects. This was associated with coagulation of the stroma in the mucosa and deeper within the submucosa. Submucosal blood vessels did not appear to be affected.

Discussion

The results of this tissue study suggest that deep tissue destruction that could lead to perforation is rare with EAPC. This would support data from clinical reports that perforation occurs only occasionally: Johanns et al.7 report 2 cases of gas in the mediastinum and peritoneal cavity after EAPC, and one case of accumulation of submucosal gas in the cecum out of 66 patients studied. In all three cases these effects were transitory, caused no symptoms, and resolved spontaneously. Grund et al.8

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    Interestingly, when comparing groups based on the year of training or number of prior APC procedures performed, there was no statistical difference in the time required to complete the test nor in the amount of total mucosal touchdowns. However, the expert assessment score was more favorable for upper year fellows (2.5 [2.5–3] vs. 3.5 [3,4]; p = 0.0139), which may reflect components of endoscopy and APC technique that were not objectively measured, such as fine tip control or the ability to respond to instruction on the post-test challenge. When comparing those who were deemed independently able to perform the APC challenge by the experts (a mean expert score of 2 or less) with those who could not, there was a significant difference between the task of drawing a square and the total number of touchdowns.

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Reprint requests: K. Matthewson, MD, Consultant Gastroenterologist, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, United Kingdom.

☆☆

Gastrointest Endosc 2000;52:342–5.

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