title: Role of argon plasma coagulation in management of bleeding GI tumors: evaluating outcomes and survival.
abstract: OBJECTIVE
  Tumor related gastrointestinal (GI) bleeding is a challenging clinical problem in cancer patients. Argon plasma coagulation (APC) is preferred for the management of bleeding arterio-venous malformations. Our objective was to assess the role of APC in the management of bleeding GI tumors.
  
  
  METHODS
  This is a retrospective review of endoscopies performed at the UT MD Anderson Cancer Center over 3 consecutive years (2009-2011). This study involved patients with primary or metastatic gastrointestinal cancer with suspected GI bleeding and interventions included were endoscopies with APC. Our main outcome measurements were immediate hemostasis rate, change in transfusion requirements, re-bleeding rate, and 30-day mortality.
  
  
  RESULTS
  Immediate hemostasis was achieved in all 10 (100%) patients, with either APC performed alone (8 patients) or with adjuvant epinephrine (2 patients). There were no procedure related complications. The pooled transfusion requirements for all 10 patients 48 hours prior to the procedure were 26 packed red blood cells units, 11 platelet units and 6 fresh frozen plasma units, while the overall requirements in the 48 hours after the procedure were 5 packed red blood cells units, 6 platelet units and no fresh frozen plasma units. Re-bleeding occurred in 3 (30%) patients during follow up. Thirty day mortality rate was 0%. Total of 7 (70%) of patients were able to continue cancer specific therapy of either chemotherapy, radiation or both.
  
  
  CONCLUSIONS
  APC is feasible and safe in routine practice to manage bleeding GI tumors. It is very effective in achieving initial hemostasis (100%) and allows majority of the patients (70%) to undergo cancer specific therapy.
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, TX, USA. sushovan.guha@uth.tmc.edu.
authors.forename: Nirav
authors.initials: N
authors.lastname: Thosani
authors.forename: Bhavana
authors.initials: B
authors.lastname: Rao
authors.forename: Yezaz
authors.initials: Y
authors.lastname: Ghouri
authors.forename: Sachin
authors.initials: S
authors.lastname: Batra
authors.forename: Gottumukkala
authors.initials: G
authors.lastname: Raju
authors.forename: Mehnaz
authors.initials: M
authors.lastname: Shafi
authors.forename: Sushovan
authors.initials: S
authors.lastname: Guha
mesh_terms: D000328:Adult; D000368:Aged; D057908:Argon Plasma Coagulation; D001803:Blood Transfusion; D016099:Endoscopy, Gastrointestinal; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D005770:Gastrointestinal Neoplasms / Q000150:complications*; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine