Skip to main content
SpringerLink
Log in

Argon Plasma Coagulation with Submucosal Saline Injection for Gastric Adenoma on Outpatient Basis

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Gastric adenoma with low-grade dysplasia (LGD) is a less progressive disease than with high-grade dysplasia; nevertheless, a certain portion of lesions can progress. The purpose of this study was to evaluate the effectiveness of argon plasma coagulation (APC) with submucosa saline injections (APC–SSI) for gastric adenoma with LGD on an outpatient department (OPD) basis. We included 57 patients with 64 lesions of gastric adenoma with LGD. Endoscopic type was flat elevated in 58 lesions and central depressed in 6 lesions. Normal saline was injected into the submucosa under the lesion before APC. APC was performed to the lesion and its surrounding mucosa. After treatment, patients underwent regular endoscopy follow-ups. One case each of pneumoperitoneum and Mallory–Weiss tearing occurred and could be managed with conservative care. One case of overt bleeding occurred after 2 weeks and was treated with APC. After 19.5 months of follow-up, four residual adenomas (6.3%) were found and treated with additional APC–SSI. Fourteen metachronous lesions were noted in eight patients (14.0%). Twelve lesions were adenoma with LGD and two lesions were intramucosal adenocarcinoma. APC–SSI is an effective and safe treatment modality for gastric adenoma with LGD on an OPD basis and it is recommended for patients with risk factors of endoscopic mucosal resection (EMR). After treatment of gastric adenoma, meticulous follow-up endoscopy is recommended for detection of metachronous lesions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

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

    CAS  PubMed  Google Scholar 

  2. Grund KE, Zindel C, Farin G. Argonplasmakoagulation in der flexiblen Endoskopie. Dtsch Med Wochenschr. 1997;122:432–438.

    Article  CAS  PubMed  Google Scholar 

  3. Wahab PJ, Mulder CJJ, den Hartog G, Thies JE. Argon plasma coagulation in flexible gastrointestinal endoscopy: pilot experiences. Endoscopy. 1997;29:176–181.

    Article  CAS  PubMed  Google Scholar 

  4. Watson JP, Bennett MK, Griffin SM, Matthewson K. The tissue effect of argon plasma coagulation on esophageal and gastric mucosa. Gastrointest Endosc. 2000;52:342–345. doi:10.1067/mge.2000.108412.

    Article  CAS  PubMed  Google Scholar 

  5. Chau CH, Siu WT, Law BK, et al. Randomized controlled trial comparing epinephrine injection plus heat probe coagulation versus epinephrine injection plus argon plasma coagulation for bleeding peptic ulcers. Gastrointest Endosc. 2003;57:455–461. doi:10.1016/S0016-5107(03)80008-1.

    Article  PubMed  Google Scholar 

  6. Cipolletta L, Bianco MA, Rotondano G, Marmo R, Meucci C, Piscopo R. Argon plasma coagulation prevents variceal recurrence after band ligation of esophageal varices: preliminary results of a prospective randomized trial. Gastrointest Endosc. 2002;56:467–471. doi:10.1016/S0016-5107(02)70428-8.

    Article  PubMed  Google Scholar 

  7. Kitamura T, Tanabe S, Koizumi W, Mitomi H, Saigenji K. Argon plasma coagulation for early gastric cancer: technique and outcome. Gastrointest Endosc. 2006;63:48–54. doi:10.1016/j.gie.2005.08.009.

    Article  PubMed  Google Scholar 

  8. Rolachon A, Papillon E, Fournet J. Is argon plasma coagulation an efficient treatment for digestive system vascular malformation and radiation proctitis? Gastroenterol Clin Biol. 2000;24:1205–1210.

    CAS  PubMed  Google Scholar 

  9. Sagawa T, Takayama T, Oku T, et al. Argon plasma coagulation for successful treatment of early gastric cancer with intramucosal invasion. Gut. 2003;52:334–339. doi:10.1136/gut.52.3.334.

    Article  CAS  PubMed  Google Scholar 

  10. Murakami M, Nishino K, Inoue A, et al. Argon plasma coagulation for the treatment of early gastric cancer. Hepatogastroenterology. 2004;51:1658–1661.

    PubMed  Google Scholar 

  11. Lauwers GY, Riddell RH. Gastric epithelial dysplasia. Gut. 1999;45:784–790.

    Article  CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  13. Morson BC, Sobin LH, Grundmann E, Johansen A, Nagayo T, Serck-Hanssen A. Precancerous conditions and epithelial dysplasia in the stomach. J Clin Pathol. 1980;33:711–721. doi:10.1136/jcp.33.8.711.

    Article  CAS  PubMed  Google Scholar 

  14. Kamiya T, Morishita T, Asakura H, Miura S, Munakata Y, Tsuchiya M. Long-term follow-up study on gastric adenoma and its relation to gastric protruded carcinoma. Cancer. 1982;50:2496–2503. doi:10.1002/1097-0142(19821201)50:11<2496::AID-CNCR2820501140>3.0.CO;2-1.

    Article  CAS  PubMed  Google Scholar 

  15. Rugge M, Farinati F, Baffa R, et al. Gastric epithelial dysplasia in the natural history of gastric cancer: a multicenter perspective follow-up study. Gastroenterology. 1994;107:1288–1296.

    CAS  PubMed  Google Scholar 

  16. Lansdown M, Quirke P, Dixon MF, Axon AT, Johnston D. High grade dysplasia of the gastric mucosa: a marker for gastric carcinoma. Gut. 1990;31:977–983. doi:10.1136/gut.31.9.977.

    Article  CAS  PubMed  Google Scholar 

  17. O’Mahony S. Endoscopic mucosal resection for early gastric cancer. Gut. 2001;48:151–152. doi:10.1136/gut.48.2.151.

    Article  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  19. Miyata M, Yokoyama Y, Okoyama N, et al. What are the appropriate indications for endoscopic mucosal resection for early gastric cancer? Analysis of 256 endoscopically resected lesions. Endoscopy. 2000;32:773–778. doi:10.1055/s-2000-7712.

    Article  CAS  PubMed  Google Scholar 

  20. Giovannini M, Bernardini D, Moutardier V, et al. Endoscopic mucosal resection (EMR): results and prognostic factors in 21 patients. Endoscopy. 1999;31:698–701. doi:10.1055/s-1999-79.

    Article  CAS  PubMed  Google Scholar 

  21. Watanabe K, Ogata S, Kawazoe S, et al. Clinical outcomes of EMR for gastric tumors: historical pilot evaluation between endoscopic submucosal dissection and conventional mucosal resection. Gastrointest Endosc. 2006;63:776–782. doi:10.1016/j.gie.2005.08.049.

    Article  PubMed  Google Scholar 

  22. Fujishiro M, Yahagi N, Kashimura K, et al. Comparison of various submucosal injection solutions for maintaining mucosal elevation during endoscopic mucosal resection. Endoscopy. 2004;36:579–583. doi:10.1055/s-2004-814517.

    Article  CAS  PubMed  Google Scholar 

  23. Yoshida T, Kawachi H, Sasajima K, Shiokawa A, Kudo SE. The clinical meaning of a nonstructural pattern in early gastric cancer on magnifying endoscopy. Gastrointest Endosc. 2005;62:48–54. doi:10.1016/S0016-5107(05)00373-1.

    Article  PubMed  Google Scholar 

  24. Yagi K, Aruga Y, Nakamura A, Sekine A, Umezu H. The study of dynamic chemical magnifying endoscopy in gastric neoplasia. Gastrointest Endosc. 2005;62:963–969. doi:10.1016/j.gie.2005.08.050.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Ajou University School of Medicine, San-5 Woncheon-dong, Yongtong-gu, Suwon, 442-749, South Korea

    Kee Myung Lee, Sung Jae Sin, Jae Yeon Jung, Jae Chul Hwang, Sun Gyo Lim, Byung Moo Yoo, Jin Hong Kim & Sung Won Cho

  2. Department of Pathology, Ajou University School of Medicine, San-5 Woncheon-dong, Yongtong-gu, Suwon, 442-749, South Korea

    Young Bae Kim

Authors
  1. Kee Myung Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Young Bae Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sung Jae Sin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jae Yeon Jung
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jae Chul Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sun Gyo Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Byung Moo Yoo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jin Hong Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Sung Won Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jin Hong Kim.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lee, K.M., Kim, Y.B., Sin, S.J. et al. Argon Plasma Coagulation with Submucosal Saline Injection for Gastric Adenoma on Outpatient Basis. Dig Dis Sci 54, 2623–2628 (2009). https://doi.org/10.1007/s10620-008-0638-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-008-0638-7

Keywords

Search

Navigation