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

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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.

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Abbreviations

APC:

Argon plasma coagulation

EGD:

Esophagogastroduodenoscopy

EMR:

Endoscopic mucosal resection

ESD:

Endoscopic submucosal dissection

HGD:

High-grade dysplasia

LGD:

Low-grade dysplasia

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Acknowledgments

This study was supported by Grant 1110532-2 from the National Cancer Center, Korea.

Disclosures

Se Jin Jung, Soo-Jeong Cho, Ju Choi, Myeong-Cherl Kook, Chan Gyoo Kim, Jong Yeul Lee, Sook Ryun Park, Jun Ho Lee, Keun Won Ryu, and Young-Woo Kim have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Center for Gastric Cancer, National Cancer Center, 111 Jungbalsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Republic of Korea

    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

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  1. Se Jin Jung
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  2. Soo-Jeong Cho
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Correspondence to Soo-Jeong Cho.

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Jung, S.J., Cho, SJ., Choi, I.J. et al. Argon plasma coagulation is safe and effective for treating smaller gastric lesions with low-grade dysplasia: a comparison with endoscopic submucosal dissection. Surg Endosc 27, 1211–1218 (2013). https://doi.org/10.1007/s00464-012-2577-9

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