[Is argon plasma coagulation an efficient treatment for digestive system vascular malformation and radiation proctitis?].
OBJECTIVE
Argon beam coagulation is an innovative no-touch electrocoagulation technique in which high-frequency monopolar alternating current is delivered to the tissue through ionized argon gas. The aim of this prospective study was to evaluate the efficacy and safety of argon plasma coagulation (APC) for the treatment of hemorrhagic digestive vascular malformations and hemorrhagic radiation proctosigmoiditis.


METHODS
From March 1998 through April 1999, we used endoscopic APC (ERBE, Lyon, France, argon gas source ICC 300, high-frequency electrosurgical generator ICC 200, gas flow 1 L/min, power setting 50 W) to treat 39 consecutive patients (mean age 70.3 +/- 10 years). The indications for treatment were anemia (n =10), active or oozing haemorrhage (n =15) from digestive angiodysplastic lesions (n =25), hemorrhagic antral telangiectatic vascular lesions (n =2), and hemorrhagic radiation proctosigmoiditis (n =12) after failure of medical treatments (5-aminosalicylic acid, corticosteroids, or sucralfate enemas). The efficacy of APC treatment was evaluated on symptoms, transfusion requirement, bleeding recurrence, hemoglobin value before and 6 months after APC therapy.


RESULTS
On the average, 1 +/- 0.5 sessions per patient was required to treat digestive vascular malformations. Definitive haemostasis of digestive angiodysplastic lesions with active or oozing haemorrhage was achieved in one session in all patients. No bleeding recurrence was observed during the follow-up period of 6 months. Anemia recurrence was observed in 2 patients (7%). Average hemoglobin levels recorded before and 6 months after APC therapy were 78.8 +/- 21.2 g/L and 108 +/- 13.7 g/L, respectively (P<0.05). On the average, 2.8 +/- 0.8 sessions per patient were required to treat hemorrhagic radiation proctosigmoiditis. Ten patients (83%) reported improvement or cessation of rectal bleeding, most of them immediately after APC therapy. Endoscopic control was performed one month after APC therapy and showed complete disappearance of lesions in 8 patients (66%). Average hemoglobin levels recorded before and 6 months after APC therapy were of 102.7 +/- 21 g/L and 120 +/- 19.5 g/L, respectively (P <0.05). Complications were observed in 5 cases (13%): pneumoperitoneum in 2 cases, chronic rectal ulcerations in 2 cases, and nonsymptomatic rectal stenosis in 1 case.


CONCLUSIONS
APC appears to be a simple, safe, and effective technique in the management of hemorrhagic radiation-induced proctosigmoiditis and hemorrhagic lesions.
Rolachon
A
A
Département d'Hépato-Gastroentérologie, CHU, BP 217, 38043 Grenoble Cedex 9, France. ARolachon@chu-grenoble.fr
Papillon
E
E
Fournet
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001128:Argon / Q000627:therapeutic use*; D001165:Arteriovenous Malformations / Q000150:complications / Q000473:pathology / Q000601:surgery*; D001803:Blood Transfusion; D004064:Digestive System / Q000098:blood supply*; D004564:Electrocoagulation / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000097:blood / Q000209:etiology / Q000628:therapy; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011349:Proctitis / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D011878:Radiotherapy / Q000009:adverse effects*; D012008:Recurrence; D016896:Treatment Outcome
D006454:Hemoglobins; D001128:Argon