The Effect Of Opd-Based Argon Plasma Coagulation Treatment For Gastric Adenoma

Background and Aims: Gastric adenoma is regarded as a precancerous lesion, and therefore it is advisable to remove it completely when discovered. Endoscopic mucosal resection (EMR) is accepted to be the standard treatment of gastric adenoma. However, it has a relatively high risk of procedure-related complications such as bleeding and perforation, thus patients having to be admitted to hospital for several days. Argon plasma coagulation (APC) is a non-contact thermal method with coagulation to a limited and predictable depth which is suitable for treating mucosal areas. The aim of this study was to evaluate the effectiveness of APC for the treatment of gastric adenoma with a low-grade dysplasia. Methods: The study group comprised of 14 men and 6 women, diagnosed with gastric adenoma with low-grade dysplasia. OPD-based APC ablations were performed after submucosal hypertonic saline injection. We used an argon gas flow of 2 l/min at a power setting of 60 W and a maximum ablation time of 15 s/cm2. Follow-up endoscopy was performed 3 months after the procedure and more than 6 biopsy specimens were taken routinely from the ablated site. Results: All lesions were ablated with APC successfully without serious immediate complications such as major bleeding or perforation. Minor bleeding occurred in 2 patients (10%). One case of bleeding occurred during the procedure and the other case occurred 20 days after the procedure, which was easily controlled with endoscopic hemostasis. Abdominal pain occurred in 6 patients (30%). One of them was treated with analgesics and the remaining 5 patients' symptoms spontaneously improved. In all patients, there was no evidence of recurrence after the first 3 month follow-up examination. Conclusions: OPD-based APC seems to be a safe, effective and less invasive treatment modality for gastric adenoma with a low grade dysplasia without serious complications, although pathologic confirmation is not available. Background and Aims: Gastric adenoma is regarded as a precancerous lesion, and therefore it is advisable to remove it completely when discovered. Endoscopic mucosal resection (EMR) is accepted to be the standard treatment of gastric adenoma. However, it has a relatively high risk of procedure-related complications such as bleeding and perforation, thus patients having to be admitted to hospital for several days. Argon plasma coagulation (APC) is a non-contact thermal method with coagulation to a limited and predictable depth which is suitable for treating mucosal areas. The aim of this study was to evaluate the effectiveness of APC for the treatment of gastric adenoma with a low-grade dysplasia. Methods: The study group comprised of 14 men and 6 women, diagnosed with gastric adenoma with low-grade dysplasia. OPD-based APC ablations were performed after submucosal hypertonic saline injection. We used an argon gas flow of 2 l/min at a power setting of 60 W and a maximum ablation time of 15 s/cm2. Follow-up endoscopy was performed 3 months after the procedure and more than 6 biopsy specimens were taken routinely from the ablated site. Results: All lesions were ablated with APC successfully without serious immediate complications such as major bleeding or perforation. Minor bleeding occurred in 2 patients (10%). One case of bleeding occurred during the procedure and the other case occurred 20 days after the procedure, which was easily controlled with endoscopic hemostasis. Abdominal pain occurred in 6 patients (30%). One of them was treated with analgesics and the remaining 5 patients' symptoms spontaneously improved. In all patients, there was no evidence of recurrence after the first 3 month follow-up examination. Conclusions: OPD-based APC seems to be a safe, effective and less invasive treatment modality for gastric adenoma with a low grade dysplasia without serious complications, although pathologic confirmation is not available.