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 26 February 2018

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News

Argon plasma coagulation prevents recurrence of esophageal varices

Argon plasma coagulation after eradication of esophageal varices by endoscopic variceal ligation is safe and effective for reducing the rate of variceal recurrence, claims a team from Torre del Greco, Italy.

News image

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The investigators determined whether argon plasma coagulation is effective in reducing variceal recurrence after endoscopic ligation of esophageal varices.

The results of the trial were reported in the October issue of Gastrointestinal Endoscopy.

Some 30 patients with cirrhosis, a history of acute esophageal variceal bleeding, and eradication of varices by endoscopic variceal ligation were enrolled in the study.

Each was randomized to argon plasma coagulation (n = 16) or observation (n = 14).

The 2 groups were similar with respect to all background variables, including age, Child-Pugh score, presence of gastric varices, and degree of portal hypertensive gastropathy.

In the argon plasma coagulation group, the entire esophageal mucosa, 4 to 5 cm proximal to the esophagogastric junction, was thermocoagulated circumferentially with argon plasma coagulation. The researchers performed 1 to 3 sessions at weekly intervals.

Endoscopy was conducted every 3 months to check for recurrence of varices in both groups.

During the course of the study, no serious complication was noted.

Variceal recurrence:
Argon plasma coagulation: 0%
Control group: 43%
Gastrointestinal Endoscopy

After argon plasma coagulation, transient fever occurred in 13 patients and 8 complained of dysphagia or retrosternal pain/discomfort.

Mean follow-up for all patients was 16 months.

The authors observed no recurrence of varices or variceal hemorrhage in the argon plasma coagulation group.

On the other hand, varices recurred in 43% of the patients in the control group and bleeding recurred in 7%.

Dr Livio Cipolletta concluded on behalf of fellow authors, "Argon plasma coagulation of the distal esophageal mucosa after eradication of esophageal varices by endoscopic variceal ligation is safe and effective for reducing the rate of variceal recurrence."

In an accompanying Editorial, Drs Marrero and Scheiman comment that, "Argon plasma coagulation after esophageal variceal eradication potentially represents an innovative new intervention for endoscopists caring for patients with variceal bleeding.

"However, before argon plasma coagulation can be recommended as an adjuvant therapy, after variceal eradication, the results of this study must be confirmed by other groups including larger trials to assess bleeding events."

"For now, the consensus is that endoscopic band ligation in combination with beta-blockers, with or without nitrates, should be the treatment of choice for prevention of variceal recurrent bleeding," the authors from the University of Michigan, Ann Arbor, Michigan, USA, conclude.

Gastrointest Endosc 2002; 56: 467-71
27 September 2002

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