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The initial experience of safety and efficacy of argon plasma coagulation (APC) in the primary prevention of variceal bleeding.
MedLine Citation:
PMID:  23122453     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND AND STUDY AIMS: The well-known complications of variceal bleeding together with the high mortality rate mandate effective prophylaxis. Because of the intolerance, failure of response and lack of compliance related to B blockers and because of the high incidence of variceal recurrence after endoscopic variceal ligation (EVL), other alternatives should be investigated. As APC provides coagulation at a shallow depth, it has been considered an ideal procedure to promote mucosal fibrosis for oesophageal varices. This study aims to investigate the safety and effectiveness of APC application to the oesophagus post-variceal obliteration in an attempt to decrease variceal recurrence and bleeding, as compared to EVL.
PATIENTS AND METHODS: This study included 60 patients with chronic liver disease and portal hypertension referred to the Gastrointestinal Endoscopy Unit, Kasr Al-Aini Hospital, Cairo University, during the period from August 2008 till January 2010. Patients had to have large-sized varices (F3), without history of bleeding, portal hypotensive drugs or intervention. Patients were allocated into either group I that included 30 patients for whom EVL was performed and sequentially followed by one session of APC or group II that included 30 patients for whom EVL alone was done. Patients underwent surveillance endoscopy at 3 and 6months to evaluate variceal recurrence (F1 or more).
RESULTS: Both groups were comparable in terms of the demographic features, hepatic functional reserve and endoscopic findings. Post-APC, fever was reported in 6.7%, dysphagia in 3.3%, procedure-related bleeding in 0% and stricture in 3.3%. At 3 and 6months follow-up, both groups were comparable in terms of variceal recurrence and none of the patients in both groups developed variceal bleeding.
CONCLUSION: Although, APC application to the oesophageal mucosa is a safe technique, its additive benefit in terms of variceal recurrence and re-bleeding is comparable to EVL alone. This is encountered when only a single session of APC is applied. A more beneficial effect of multiple sessions of APC awaits further studies.
Authors:
I Hamza; M Mahmoud; S Labib
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Publication Detail:
Type:  Journal Article     Date:  2012-09-19
Journal Detail:
Title:  Arab journal of gastroenterology : the official publication of the Pan-Arab Association of Gastroenterology     Volume:  13     ISSN:  2090-2387     ISO Abbreviation:  Arab J Gastroenterol     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-11-05     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101298363     Medline TA:  Arab J Gastroenterol     Country:  Egypt    
Other Details:
Languages:  eng     Pagination:  125-9     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Arab Journal of Gastroenterology. Published by Elsevier Ltd. All rights reserved.
Affiliation:
Tropical Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt. Electronic address: iman_hamza@hotmail.com.
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