Endoscopic argon plasma coagulation (APC) first clinical experiences in flexible endoscopy

Abstract

Argon plasma coagulation (APC) is a new mode of non-contact electrocoagulation in which current is applied to tissues by means of ionised argon gas (argon plasma). In open surgery, APC is used for the haemostasis of superficial, diffuse haemorrhages from parenchymatous organs and for the devitalization of various tissues. Experimental studies have shown the superiority of APC to standard electrocoagulation modes and surgical techniques due to its efficiency and limited tissue traumatisation. After developing and designing special probes which can be applied through flexible endoscopes and after testing these in in vitro studies, we have been able to utilise APC in both the gastrointestinal tract and the tracheobronchial system. From June, 1991 to September, 1992, 102 patients were treated endoscopically in 189 sessions with APC in the upper and lower gastrointestinal tract as well as in the respiratory system. The indications were malignant and benign tumours, diffuse haemorrhages of various origins and sites, tissue overgrowth after stent implantation, tissue remnants after endoscopic adenomectomy, and the conditioning of fistulas prior to fibrin sealing. In all cases, APC in flexible endoscopy was highly effective and easy to perform, with advantages over standard electrocoagulation. No problems or complications were observed. The limited depth of tissue coagulation (2-3 mm) with concomitant, efficient tissue coagulation allows application even in critical areas where there is risk of perforation, such as the duodenum or colon. For many indications, APC has replaced the Nd:YAG-laser, which was formerly used widely in our unit, Except for vaporisation of extended tumours, the APC shows remarkable advantages in nearly all applications.(ABSTRACT TRUNCATED AT 250 WORDS)