Gastric pneumatosis after endoscopic argon plasma coagulation

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Medical Complications

Background:

• Argon plasma coagulation (APC) is increasingly utilized for endoscopic hemostasis.
• The risks associated with APC, particularly in the context of post-radiotherapy gastric conditions, are not fully elucidated.
• Radiation gastritis following gastric carcinoma treatment presents unique challenges for endoscopic intervention.

Observation:

• A 74-year-old male, treated for gastric carcinoma with radiotherapy 6 months prior, presented with anemia and melena.
• Gastroscopy revealed hemorrhagic radiation gastritis, for which endoscopic APC was initiated.
• During APC, the patient experienced severe epigastric pain, leading to procedure termination and subsequent CT scan revealing gastric pneumatosis.

Findings:

• Gastric pneumatosis, a rare complication, was identified following endoscopic APC for radiation gastritis.
• The patient's symptoms resolved with conservative management, including rest and observation.
• Subsequent APC sessions were tolerated, and hemoglobin levels remained stable at 10 months post-treatment, indicating successful long-term hemostasis.

Implications:

• This case underscores the importance of recognizing gastric pneumatosis as a potential complication of endoscopic APC.
• Awareness and prompt management are crucial for mitigating the risks associated with this endoscopic hemostasis technique.
• Endoscopists should maintain a high index of suspicion for gastric pneumatosis in patients undergoing APC, especially those with a history of radiotherapy.