The Long Term Therapeutic Effect Of Argon Plasma Coagulation Of Gastric Adenoma On Opd-Based

Background and Aims: Gastric adenoma is regarded as a precancerous lesion, and endoscopic mucosal resection (EMR) is accepted to be the standard treatment of gastric adenoma. However, it has a risk of procedure-related complications such as bleeding and perforation. Thus, patients have to be admitted to hospital for several days. Argon plasma coagulation (APC) is a non-contact thermal method with coagulation of a limited and predictable depth. The aim of this study is to evaluate the therapeutic effect of APC for the treatment of gastric adenoma with a low-grade dysplasia. Methods and Patients: 65 gastric adenomas with low-grade dysplasia in 59 patients were treated by APC ablation. Male to female ratio was 3.9:1.53 adenomas in 49 patients were followed up, the mean period of follow-up was 27.8 ± 17.8 (range 12-60) weeks. APC ablations was done 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 endoscopies were performed 3, 9, 15 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 3 patients (4.5%) and it could be easily controlled with endoscope. Transient abdominal pain occurred in 11 patients (18.6%) and it was relieved with conservative care. Follow-up endoscopic biopsy at 9 months after the procedure identified two recurrences (3.8%) and four new metachronous gastric adenomas (8.2%) including high grade dysplasia. Conclusions: OPD-based APC appeared to be a safe, effective and less invasive treatment modality for gastric adenoma with a low grade dysplasia without serious complications. Meticulous endoscopic follow-up should be performed for detection of residual, missed, recurrent lesion and metachronous lesion.