Submucosal Injection of Normal Saline can Prevent Unexpected Deep Thermal Injury of Argon Plasma Coagulation in the in vivo Porcine Stomach.
OBJECTIVE
There have been several reports of thermal injury induced by argon plasma coagulation (APC) in animal models, but no follow-up studies have revealed the actual thermal injury.


METHODS
APC was performed on the stomachs of two living minipigs with and without prior submucosal injection of normal saline. The power and argon gas flow were set to 60 watts and 2 L/min, respectively, and pulse durations of 5, 10, and 20 seconds were used. One of the minipigs was killed immediately thereafter and the other was killed 1 week later.


RESULTS
The minipig killed immediately showed only subtle differences between noninjected and injected injuries under all the conditions, and the usefulness of prior submucosal injection was not obvious. However, the minipig killed 1 week later had a deep ulcer extending to the deeper muscle layer at the noninjected site where APC had been applied for 20 seconds, whereas tissue injury of the injected site was limited to the submucosal layer.


CONCLUSIONS
Unexpected tissue damage can occur even using a short-duration APC. Prior submucosal injection for APC might be a safer alternative technique, especially in a thinner and narrower gut wall.
Fujishiro
Mitsuhiro
M
Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Japan.
Kodashima
Shinya
S
Ono
Satoshi
S
Goto
Osamu
O
Yamamichi
Nobutake
N
Yahagi
Naohisa
N
Kashimura
Koji
K
Matsuura
Toyokazu
T
Iguchi
Mikitaka
M
Oka
Masashi
M
Ichinose
Masao
M
Omata
Masao
M