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NEW ARGON PLASMA COAGULATION METHOD FOR SUPERFICIAL ESOPHAGEAL CARCINOMAS: ARGON PLASMA COAGULATION‐SUBEPITHELIAL ABLATION
Author(s) -
Kawada Kenro,
Kawano Tatsuyuki,
Momma Kumiko,
Fujiwara Junko,
Nagai Kagami,
Nishikage Tetsurou,
Nakajima Yasuaki,
Ogiya Kazuo,
Tanaka Koji,
Haruki Shigeo,
Iwai Takehisa
Publication year - 2007
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/j.1443-1661.2007.00702.x
Subject(s) - argon plasma coagulation , ablation , medicine , esophagus , endoscope , endoscopy , perforation , radiology , surgery , pathology , materials science , metallurgy , punching
Argon plasma coagulation (APC) has been introduced to the field of therapeutic endoscopy and is now widely used. A new ablation technique is herein proposed for the treatment of superficial esophageal carcinomas. According to this technique, after the initial ablation, we exfoliate the epithelium and then perform a second ablation (APC‐subepithelial ablation). APC is applied at a power/gas setting of 60 W and 2l min in the esophagus. The APC applicator is inserted through the working channel of the endoscope, and a transparent hood is then set at the tip of the endoscope. At first, lines are traced around the tumor. Next, the initial ablation is made in a uniform manner. A transparent hood is then attached to the ablated tumor and, thereafter, the epithelium is easily exfoliated. The muscularis mucosae are preserved. We next identify any remaining non‐uniform ablation areas and then a second ablation is made on those areas. To obtain a complete eradication of the mucosal and submucosal tissue, the endoscopic appearance of brownish subepithelial tissue following the secondary argon plasma irradiation after epithelial exfoliation with initial argon plasma irradiation is needed. The secondary ablation could thus safely ablate at the esophageal gland level. The procedure is minimally invasive and easy to apply. A total of 48 patients with superficial esophageal squamous cell carcinoma were treated between February 2000 and April 2006 (median follow up 46 months). One hundred and sixty one sessions were performed with no major complications (no bleeding, no perforation, and no stenosis). The technique is thus considered to be safe.