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Usefulness of argon plasma coagulation ablation subsequent to endoscopic snare papillectomy for ampullary adenoma
Author(s) -
Nam Kwangwoo,
Song Tae Jun,
Kim Raymond E.,
Cho Dong Hui,
Cho Min Keun,
Oh Dongwook,
Park Do Hyun,
Lee Sang Soo,
Seo DongWan,
Lee Sung Koo,
Kim MyungHwan,
Baek Seunghee
Publication year - 2018
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.13008
Subject(s) - argon plasma coagulation , medicine , gastroenterology , perforation , adenoma , odds ratio , ablation , surgery , endoscopy , materials science , punching , metallurgy
Background and Aim Endoscopic snare papillectomy ( ESP ) is an effective treatment for ampullary adenoma. Argon plasma coagulation ( APC ) is widely used as an additional method to control bleeding or ablate the residual tumor. However, the efficacy of this procedure has not yet been fully evaluated. This study aimed to evaluate the usefulness of APC as an additional method to ESP . Methods Patients who underwent ESP for ampullary adenoma between September 2005 and September 2015 were retrospectively reviewed. Using propensity score matching, we compared short‐ and long‐term outcomes between the ESP ‐with‐additional‐ APC group ( ESP + APC group) and the ESP ‐only group. Primary outcome was early post‐ ESP adverse events ( AE ), and secondary outcomes were late AE and recurrence. Results Among 109 patients, additional APC was carried out in 59 (54.1%) patients. After matching, 41 patients were included in both groups, respectively. Bleeding rate was significantly lower in the ESP + APC group than in the ESP ‐only group (7.3% vs 31.7%, odds ratio = 0.180, P < 0.01). However, there were no significant differences in other procedure‐related early AE such as pancreatitis (12.2% vs 19.5%, P = 0.365), cholangitis (2.4% vs 9.8%, P = 0.198), and perforation (2.4% vs 2.4%, P = 1.000) between the ESP + APC group and the ESP ‐only group. During the follow‐up period (mean 904 ± 868 days), papillary stricture (9.8% vs 4.9%, P = 0.405) and recurrence rates (24.4% vs 24.4%, P = 0.797) were not significantly different between the ESP + APC group and the ESP ‐only group. Conclusion Additional APC during ESP may have a beneficial effect by decreasing bleeding rate without harmful effects.