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01-04-2013

Argon plasma coagulation is safe and effective for treating smaller gastric lesions with low-grade dysplasia: a comparison with endoscopic submucosal dissection

Authors: Se Jin Jung, Soo-Jeong Cho, Il Ju Choi, Myeong-Cherl Kook, Chan Gyoo Kim, Jong Yeul Lee, Sook Ryun Park, Jun Ho Lee, Keun Won Ryu, Young-Woo Kim

Published in: Surgical Endoscopy | Issue 4/2013

Abstract

Background and aims

The best therapeutic modality has not been established for gastric low-grade adenomas or dysplasia (LGD), which can progress to invasive carcinoma despite a low risk. This study aims to investigate the clinical efficacy, safety, and local recurrence after argon plasma coagulation (APC) treatment of gastric LGD compared with endoscopic submucosal dissection (ESD).

Patients and methods

A total of 320 patients with gastric LGD ≤2.0 cm treated with APC or ESD between 2004 and 2011 were retrospectively analyzed. We compared local recurrence rate, complication rate, procedure time, and admission to hospital between APC and ESD groups.

Results

Of the 320 patients, 116 patients were treated with APC and 204 with ESD. During follow-up, local recurrence was more common in the APC group (3.8 %, 4/106) than the ESD group (0.5 %, 1/188; log-rank test P = 0.036). However, all patients with local recurrence (n = 5) were treated by additional APC, and followed up without further recurrences. ESD was complicated by two perforations (1.0 %, 2/204) compared with no perforations in the APC group (0 %, 0/116). Bleeding complications were not different between the APC (1.7 %, 2/116) and ESD (2.0 %, 4/204) groups. Procedure time was shorter in the APC (7.8 ± 5.1 min) than the ESD (53.1 ± 38.1 min) group (P < 0.001). The proportion of hospitalization was less in the APC group (31.0 %, 36/116) than the ESD group (100.0 %, 204/204) (P < 0.001).

Conclusions

APC can be a good treatment option for patients with LGD ≤2.0 cm.

Di Gregorio C, Morandi P, Fante R, De Gaetani C (1993) Gastric dysplasia. A follow-up study. Am J Gastroenterol 88:1714–1719PubMed

Lauwers GY, Riddell RH (1999) Gastric epithelial dysplasia. Gut 45:784–790PubMedCrossRef

Morson BC, Sobin LH, Grundmann E et al (1980) Precancerous conditions and epithelial dysplasia in the stomach. J Clin Pathol 33:711–721PubMedCrossRef

Chung IK, Lee JH, Lee SH et al (2009) Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study. Gastrointest Endosc 69:1228–1235PubMedCrossRef

Kamiya T, Morishita T, Asakura H et al (1982) Long-term follow-up study on gastric adenoma and its relation to gastric protruded carcinoma. Cancer 50:2496–2503PubMedCrossRef

Lansdown M, Quirke P, Dixon MF, Axon AT, Johnston D (1990) High grade dysplasia of the gastric mucosa: a marker for gastric carcinoma. Gut 31:977–983PubMedCrossRef

Rugge M, Farinati F, Baffa R et al (1994) Gastric epithelial dysplasia in the natural history of gastric cancer: a multicenter prospective follow-up study. Interdisciplinary Group on Gastric Epithelial Dysplasia. Gastroenterology 107:1288–1296PubMed

Giovannini M, Bernardini D, Moutardier V et al (1999) Endoscopic mucosal resection (EMR): results and prognostic factors in 21 patients. Endoscopy 31:698–701PubMedCrossRef

Watanabe K, Ogata S, Kawazoe S et al (2006) Clinical outcomes of EMR for gastric tumors: historical pilot evaluation between endoscopic submucosal dissection and conventional mucosal resection. Gastrointest Endosc 63:776–782PubMedCrossRef

10.

Cho SJ, Choi IJ, Kim CG et al (2011) Risk of high-grade dysplasia or carcinoma in gastric biopsy-proven low-grade dysplasia: an analysis using the Vienna classification. Endoscopy 43:465–471PubMedCrossRef

11.

Onozato Y, Ishihara H, Iizuka H et al (2006) Endoscopic submucosal dissection for early gastric cancers and large flat adenomas. Endoscopy 38:980–986PubMedCrossRef

12.

Grund KE, Storek D, Farin G (1994) Endoscopic argon plasma coagulation (APC) first clinical experiences in flexible endoscopy. Endosc Surg Allied Technol 2:42–46PubMed

13.

Grund KE, Zindel C, Farin G (1997) Argon plasma coagulation through a flexible endoscope. Evaluation of a new therapeutic method after 1606 uses. Dtsch Med Wochenschr 122:432–438PubMedCrossRef

14.

Wahab PJ, Mulder CJ, den Hartog G, Thies JE (1997) Argon plasma coagulation in flexible gastrointestinal endoscopy: pilot experiences. Endoscopy 29:176–181PubMedCrossRef

15.

Sagawa T, Takayama T, Oku T et al (2003) Argon plasma coagulation for successful treatment of early gastric cancer with intramucosal invasion. Gut 52:334–339PubMedCrossRef

16.

Tada M, Murata M, Murakami F et al (1984) Development of the strip-off biopsy. Gastroenterol Endosc (in Japanese) 26:833–839

17.

Yanai H, Matsubara Y, Kawano T et al (2004) Clinical impact of strip biopsy for early gastric cancer. Gastrointest Endosc 60:771–777PubMedCrossRef

18.

Inoue H, Takeshita K, Hori H et al (1993) Endoscopic mucosal resection with a cap-fitted panendoscope for esophagus, stomach, and colon mucosal lesions. Gastrointest Endosc 39:58–62PubMedCrossRef

19.

Choi IJ, Kim CG, Chang HJ et al (2005) The learning curve for EMR with circumferential mucosal incision in treating intramucosal gastric neoplasm. Gastrointest Endosc 62:860–865PubMedCrossRef

20.

Participants in Paris Workshop (2003) The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 58:S3–43

21.

Gotoda T (2005) A large endoscopic resection by endoscopic submucosal dissection procedure for early gastric cancer. Clin Gastroenterol Hepatol 3:S71–S73PubMedCrossRef

22.

Lee JY, Choi IJ, Cho SJ et al (2010) Endoscopic submucosal dissection for metachronous tumor in the remnant stomach after distal gastrectomy. Surg Endosc 24:1360–1366PubMedCrossRef

23.

Cho SJ, Choi IJ, Kim CG et al (2012) Aspirin use and bleeding risk after endoscopic submucosal dissection in patients with gastric neoplasms. Endoscopy 44:114–121PubMedCrossRef

24.

Weinstein WM, Goldstein NS (1994) Gastric dysplasia and its management. Gastroenterology 107:1543–1545PubMed

25.

Rugge M, Nitti D, Farinati F, di Mario F, Genta RM (2005) Non-invasive neoplasia of the stomach. Eur J Gastroenterol Hepatol 17:1191–1196PubMedCrossRef

26.

Dinis-Ribeiro M, Areia M, de Vries AC et al (2012) Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED). Endoscopy 44:74–94PubMedCrossRef

27.

Takeshita K, Tani M, Inoue H et al (1997) A new method of endoscopic mucosal resection of neoplastic lesions in the stomach: its technical features and results. Hepatogastroenterology 44:1602–1611PubMed

28.

Miyata M, Yokoyama Y, Okoyama N et al (2000) What are the appropriate indications for endoscopic mucosal resection for early gastric cancer? Analysis of 256 endoscopically resected lesions. Endoscopy 32:773–778PubMedCrossRef

29.

O’Mahony S (2001) Endoscopic mucosal resection for early gastric cancer. Gut 48:151–152PubMedCrossRef

30.

Kang KJ, Kim KM, Min BH, Lee JH, Kim JJ (2011) Endoscopic submucosal dissection of early gastric cancer. Gut Liver 5:418–426PubMedCrossRef

31.

Chau CH, Siu WT, Law BK et al (2003) Randomized controlled trial comparing epinephrine injection plus heat probe coagulation versus epinephrine injection plus argon plasma coagulation for bleeding peptic ulcers. Gastrointest Endosc 57:455–461PubMedCrossRef

32.

Cipolletta L, Bianco MA, Rotondano G et al (2002) Argon plasma coagulation prevents variceal recurrence after band ligation of esophageal varices: preliminary results of a prospective randomized trial. Gastrointest Endosc 56:467–471PubMedCrossRef

33.

Kitamura T, Tanabe S, Koizumi W, Mitomi H, Saigenji K (2006) Argon plasma coagulation for early gastric cancer: technique and outcome. Gastrointest Endosc 63:48–54PubMedCrossRef

34.

Imagawa A, Okada H, Kawahara Y et al (2006) Endoscopic submucosal dissection for early gastric cancer: results and degrees of technical difficulty as well as success. Endoscopy 38:987–990PubMedCrossRef

35.

Lee KM, Kim YB, Sin SJ et al (2009) Argon plasma coagulation with submucosal saline injection for gastric adenoma on outpatient basis. Dig Dis Sci 54:2623–2628PubMedCrossRef

36.

Tomita T, Arai E, Kohno T et al (2011) Outcomes of treatment of argon plasma coagulation therapy in elderly or high-risk patients with early gastric cancer: a comparison of outcomes among experienced and nonexperienced endoscopists. J Clin Gastroenterol 45:e54–e59PubMedCrossRef

Title: Argon plasma coagulation is safe and effective for treating smaller gastric lesions with low-grade dysplasia: a comparison with endoscopic submucosal dissection
Authors: Se Jin Jung
Soo-Jeong Cho
Il Ju Choi
Myeong-Cherl Kook
Chan Gyoo Kim
Jong Yeul Lee
Sook Ryun Park
Jun Ho Lee
Keun Won Ryu
Young-Woo Kim
Publication date: 01-04-2013
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 4/2013
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-012-2577-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Argon plasma coagulation is safe and effective for treating smaller gastric lesions with low-grade dysplasia: a comparison with endoscopic submucosal dissection

Abstract

Background and aims

Patients and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background and aims

Patients and methods

Results

Conclusions

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