Argon plasma coagulation with submucosal saline injection for gastric adenoma on outpatient basis.
Gastric adenoma with low-grade dysplasia (LGD) is a less progressive disease than with high-grade dysplasia; nevertheless, a certain portion of lesions can progress. The purpose of this study was to evaluate the effectiveness of argon plasma coagulation (APC) with submucosa saline injections (APC-SSI) for gastric adenoma with LGD on an outpatient department (OPD) basis. We included 57 patients with 64 lesions of gastric adenoma with LGD. Endoscopic type was flat elevated in 58 lesions and central depressed in 6 lesions. Normal saline was injected into the submucosa under the lesion before APC. APC was performed to the lesion and its surrounding mucosa. After treatment, patients underwent regular endoscopy follow-ups. One case each of pneumoperitoneum and Mallory-Weiss tearing occurred and could be managed with conservative care. One case of overt bleeding occurred after 2 weeks and was treated with APC. After 19.5 months of follow-up, four residual adenomas (6.3%) were found and treated with additional APC-SSI. Fourteen metachronous lesions were noted in eight patients (14.0%). Twelve lesions were adenoma with LGD and two lesions were intramucosal adenocarcinoma. APC-SSI is an effective and safe treatment modality for gastric adenoma with LGD on an OPD basis and it is recommended for patients with risk factors of endoscopic mucosal resection (EMR). After treatment of gastric adenoma, meticulous follow-up endoscopy is recommended for detection of metachronous lesions.
Lee
Kee Myung
KM
Department of Gastroenterology, Ajou University School of Medicine, San-5 Woncheon-dong, Yongtong-gu, Suwon 442-749, South Korea. lkm5104@ajou.ac.kr
Kim
Young Bae
YB
Sin
Sung Jae
SJ
Jung
Jae Yeon
JY
Hwang
Jae Chul
JC
Lim
Sun Gyo
SG
Yoo
Byung Moo
BM
Kim
Jin Hong
JH
Cho
Sung Won
SW
D000230:Adenocarcinoma / Q000473:pathology; D000236:Adenoma / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D057908:Argon Plasma Coagulation / Q000009:adverse effects; D001706:Biopsy; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D016609:Neoplasms, Second Primary; D056910:Republic of Korea; D012965:Sodium Chloride / Q000008:administration & dosage*; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
D012965:Sodium Chloride