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Endoscopic Biopsy Demonstrating High-Grade Dysplasia in Barrett’s Esophagus
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Complete ablation of longer segments is best achieved by thermal ablation. radiofrequency ablation is the most commonly applied technique. It uses proprietary single use equipment to burn and destroy the mucosa, but not submucosa, of the distal esophagus. Devices can be used to treat the full circumference of the esophagus or targeted areas. Generally, 2–3 treatment sessions are required to ablate the Barrett’s segment. Argon plasma coagulation is sometimes used as a cheaper alternative to radiofrequency ablation to deal with smaller residual areas of Barrett’s esophagus following initial circumferential ablation.
Oesophageal cancer
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Nyree Griffin, Jason Dunn, Lee Alexander Grant
Transendoscopic ablation by laser photocoagulation of obstructing intraluminal tumours is a safe technique for palliation of dysphagia with functional success ranging between 70% and 80% (89). Argon plasma coagulation can also be performed via the endoscopic route, resulting in thermally induced tissue necrosis of the tumour and palliation of dysphagia (90).
Gastric antral vascular ectasia (GAVE)
Published in Mohammad Ibrarullah, Atlas of Diagnostic Endoscopy, 2019
Gastric antral vascular ectasia (GAVE) accounts for nearly 4% of non-variceal UGI bleeding. The entity commonly occurs in association with chronic liver disease, chronic renal failure, autoimmune connective tissue disorder, bone marrow transplantation, ischemic or valvular heart disease, hypertension, familial Mediterranean anemia and acute myeloid anemia. The pathogenesis of the entity is not clearly understood. The presentation ranges from occult to frank GI bleeding. Two types of lesions have been identified on endoscopy: punctuate or striped. Because of similarity in appearance, the striped variety is also known as “watermelon” stomach. Though the antral region shows predominant involvement, occasionally it may extend to the gastric fundus as well. In chronic liver disease, it must be differentiated from portal hypertensive gastropathy as the treatment modalities for both are quite different. Unlike PHG, reduction in portal pressure has no effect on GAVE. Argon plasma coagulation, laser photocoagulation and heater probe application are the accepted modalities of treatment. Rarely, antrectomy may be required for uncontrolled hemorrhage.
Improving clinical outcomes of Barrett’s esophagus with high dose proton pump inhibitors and cryoablation
Published in Annals of Medicine, 2023
Recent reports of possible serious PPI adverse effects have heightened general concern; although these adverse effects are unconfirmed, avoiding overuse is valid [1,2,9–11]. However, once BE is found, benefits far outweigh risks since PPIs reduce the chance of progression of IM to EAC, although they rarely cause BE to regress or be eliminated [1,2,10,12–14]. Radiofrequency ablation (RFA) has been evaluated extensively to treat the various stages of BE successfully [1,3–6,15–18]. Results for argon plasma coagulation (APC) have been more variable, but a recent study achieved over 90% complete remission over 108 months [19]. However, both methods of ablation cause significant pain and other adverse events such as perforation or stricture [3–6,8,12,17–20]. Studies have shown cryoablation using −196 °C liquid nitrogen (CRYO) to be effective to treat BE even after other of ablation methods including RFA have failed [20,21]. Because (a) benefits/risks ablation of NDBE are still debated despite studies showing its effectiveness [8,22], (b) in 2008 CRYO appeared to have an improved safety profile, and (c) even after a 2015 international consensus conference, there is a lack of consensus of management of BE [1], a prospective, observational long-term follow-up cohort study was designed in 2008 to evaluate the safety and long-term effectiveness of CRYO with proton-pump inhibitors given twice daily (PPI-BID) for treating BE of any stage.
Endoscopic resection of large subepithelial esophageal lesions via submucosal tunneling endoscopic resection and endoscopic submucosal dissection: a single-center, retrospective cohort study
Published in Scandinavian Journal of Gastroenterology, 2022
Bin Yang, Huazhong Han, Jianhong Shen, Pinxiang Lu, Fei Jiang
ESD was carried out with a single channel endoscope (GIT-H260; Olympus, Japan). Before inserting the gastroscope, a short and transparent cap (ND-201-11802, Olympus, Japan) was attached to its tip to provide a constant endoscopic view and constant tension to the connective tissue for dissection. The other equipment and accessories employed for these procedures included a hybrid Knife system (ICC 200, Erbe, Germany), an argon plasma coagulation unit (APC 300; ERBE), an injection needle (INJ1-A1; Medwork, Germany), an insulated-tip (IT) knife (KD-611; Olympus), a hook knife (KD-620LR; Olympus), and hemostatic forceps (FD-410-LR; Olympus). All the ESD procedures were performed with patients under general anesthesia. The standard ESD steps are performed as follows (Figure 2). The knife and hemostatic forceps were utilized for hemostasis whenever active bleeding was detected. Argon plasma coagulation was employed to coagulate any exposed vessels to decrease the risk of delayed bleeding.
Diagnosis and treatment of malignant-appearing arteriovenous malformation
Published in Baylor University Medical Center Proceedings, 2021
Rebekah John, Gurkarminder Sandhu, Christopher Naumann
The intermittent ischemia caused by contraction of the muscularis propria causes hypoxia, which is known to increase expression of proangiogenic factors. Vascular endothelial growth factor (VEGF) is one such growth factor that has been found in higher quantities in hypoxic environments.5 VEGF inhibitors have been studied in the treatment of AVMs; however, due to their extensive side effect profile, they are not commonly used for long-term treatment.6 Other therapies commonly employed in treatment of AVMs include endoscopic ligation and surgical intervention, as well as argon plasma coagulation. In argon plasma coagulation, an electrical current is combined with argon gas. The gas is ionized and allows a high-frequency electric current to be conducted to the tissue without direct contact. This method decreases tissue depth injury, especially when used in conjunction with a prior submucosal saline injection to the target area to form a cushion.7,8 Pharmacological therapy with octreotide is also commonly used. One study showed that administration of octreotide long-acting release for 6 months resulted in a significant reduction in bleeding episodes and transfusion requirements in patients who had mostly failed argon plasma coagulation therapy.9