Argon Plasma Coagulation
Argon plasma coagulation (APC) has been used to provide tissue coagulation and haemostasis since the early part of the 1990s. A stream of argon gas is passed through an endoscopic catheter; this is then ionized at the tip of the catheter by an electric current. The tip of the catheter is held close to the tissue to be treated, and the current arcs across to the tissue causing a superficial (2-3mm) burn. The lack of contact between the catheter and the tissue stops the tendency of the catheter to stick to the tissue, reducing unwanted tissue damage.
Its principal use is in providing haemostasis in gastrointestinal bleeding; angiodysplasia, GAVE, bleeding malignant tumours and bleeding peptic ulcers can all be treated. Trials have also been carried out to assess its use in eradicating Barrett’s oesophagus, but have found that relapse is common.
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Argon plasma coagulation or APC is a medical endoscopic procedure used primarily to control bleeding from certain lesions in the gastrointestinal tract, and also sometimes to debulk tumours in the case of patients for whom surgery is not recommended. It is administered during esophagogastroduodenoscopy or colonoscopy.
APC involves the use of a jet of ionized argon gas (plasma) that is directed through a probe passed through the endoscope. The probe is placed at some distance from the bleeding lesion, and argon gas is emitted then ionized by a high voltage discharge (approx 6kV). High-frequency electrical current is then conducted through the jet of gas, resulting in coagulation of the bleeding lesion on the other end of the jet. As no physical contact is made with the lesion, the procedure is safe if the bowel has been cleaned of colonic gases, and can be used to treat bleeding in parts of the gastrointestinal tract with thin walls, such as the cecum. The depth of coagulation is usually only a few millimetres.
APC is used to treat the following conditions:
- angiodysplasiae, anywhere in the GI tract
- gastric antral vascular ectasia, or watermelon stomach
- colonic polyps, after polypectomy
- radiation proctitis
- esophageal cancer