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Argon plasma coagulation: Clinical experience in pediatric patients
Khalid Khan1, Sarah Jane Schwarzenberg, Harvey Sharp
1Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA.
Insights
Argon plasma coagulation (APC) is effective for pediatric endoscopy, successfully treating bleeding lesions and granulomatous tissue in children. This minimally invasive technique demonstrated efficacy with a low complication rate in the studied pediatric population.
Area of Science:
- Gastroenterology
- Pediatric Endoscopy
- Minimally Invasive Procedures
Background:
- Argon plasma coagulation (APC) presents potential benefits for pediatric endoscopic interventions.
- Pediatric patients often have complex medical histories requiring specialized treatment approaches.
Purpose of the Study:
- To evaluate the efficacy and safety of endoscopic argon plasma coagulation (APC) in pediatric patients.
- To assess APC's utility in managing bleeding lesions and other tissue abnormalities in children.
Main Methods:
- Argon plasma coagulation (APC) was performed on 13 pediatric patients (0.05-17 years) with significant comorbidities.
- Procedures addressed bleeding lesions in the stomach, duodenum, and enterocolonic anastomosis, as well as esophageal granulomatous tissue.
- A total of 23 procedures were conducted, with 22 targeting bleeding.
Main Results:
- Hemostasis was achieved in 8 of 12 patients with bleeding lesions after a single APC session.
- Reduced blood loss and transfusion requirements were observed in 3 of 4 remaining patients.
- Complete eradication of granulomatous tissue was achieved in 2 of 3 cases; complications occurred in 2 patients (submucosal gas, scar formation).
Conclusions:
- Endoscopic argon plasma coagulation (APC) is an efficacious treatment for achieving hemostasis and performing tissue ablation in pediatric patients.
- The procedure demonstrated a low rate of minor complications (17%) in this series of pediatric cases.
Background:
Argon plasma coagulation has potential advantages in pediatric endoscopy.
Methods:
Argon plasma coagulation was applied in 13 children (age 0.05-17 years; median 3 years) with significant comorbid conditions including immunosuppression, chemotherapy, acute or chronic organ failure, and coagulopathy. Twelve had bleeding lesions; esophageal granulomatous tissue was coagulated in one. The bleeding lesion was located in the stomach in 9 of 12, the duodenum in 2 of 12 (both with granulomatous tissue), and at an enterocolonic anastomosis in 1 of 12.
Observations:
In total, 23 procedures were performed, 22 for bleeding (range 1-5 per patient). Hemostasis was achieved in 8 of 12 with one session. Blood loss and transfusion requirement were reduced in 3 of the other 4 patients. Blood loss was not affected in 1. Bleeding recurred in 3 of 12, and additional procedures were performed in 7 of 12. Granulomatous tissue was completely eradicated in 2 of 3; in one, granulomatous tissue associated with surgical staples was only partially removed. Complications occurred in 2 of 13 patients and included submucosal argon gas and scar formation.
Conclusion:
Endoscopic argon plasma coagulation is efficacious for hemostasis and tissue ablation in pediatric patients. Minor complications occurred in 17% (2/13) of cases in this series.
