Argon plasma coagulation for early gastric cancer: technique and outcome

BackgroundArgon plasma coagulation (APC) is a noncontact technique for tissue coagulation. APC has been used to treat early gastric cancer in patients who cannot undergo EMR or open surgery, but a standard procedure for APC is lacking.ObjectiveOur objectives were to assess the clinical usefulness of APC in patients with early gastric cancer.DesignThis was a small, retrospective pilot study.SettingAll patients were treated at the Department of Gastroenterology, Kitasato University East Hospital, Sagamihara, Japan.MethodsWe studied 40 patients with early gastric cancer in whom both EMR and open surgery were contraindicated. The macroscopic tumor type was superficial elevated in 11 patients, superficial depressed in 27, and superficial elevated plus superficial depressed in two. The histologic classification was intestinal type in 37 patients and diffuse type in 3.InterventionFrom January 1998 through March 1999, all patients received one session of APC. From April 1999 through August 2001, all patients received two sessions of APC. From September 2001 through March 2002, an additional session of APC was given only to patients who had large protruding lesions, depressed lesions 2 cm or greater in diameter, or submucosal invasion.Main Outcome MeasurementsThe main outcome measurements were residual tumor or recurrence of early gastric cancer.ResultsIntestinal-type intramucosal carcinoma disappeared after one or two sessions of APC. Submucosal and diffuse-type tumors had a high risk of residual tumor cells because of inadequate treatment after one session of APC. However, such lesions were locally controlled by follow-up APC.LimitationsThis was a small, retrospective pilot study. Confirmation of long-term outcome is required.ConclusionsSmall early gastric carcinomas can be successfully treated by a single session of APC. Larger protruding-type lesions and submucosal tumors are likely to require two sessions of APC.