Original articleClinical endoscopyArgon plasma coagulation treatment of hemorrhagic radiation proctopathy: the optimal settings for application and long-term outcome
Section snippets
Ex vivo experiments
Standard APC equipment consisting of a high-frequency generator (ICC 200; ERBE Elektromedizin, Tübingen, Germany), an automatically regulated argon source (APC 300; ERBE Elektromedizin), and a flexible axial spot beam APC probe (2.3 mm in diameter, 100-W maximum output, and 2.4-L/min maximum flow rate) was used in this study. Ex vivo experiments were performed to determine the optimal parameters for APC using swine rectal walls, which were obtained within 1 hour after the swine were killed. APC
Patients and methods
Eligible patients had endoscopically confirmed radiation proctopathy with rectal bleeding, had not undergone APC therapy previously, and provided informed consent. Colonoscopy was performed in all patients before treatment to rule out any other cause of the rectal bleeding. Patients undergoing APC received a standard polyethylene glycol preparation. Anticoagulants and aspirin were discontinued 1 week and 3 days before treatment, respectively.
APC was administered by using a single-channel
Ex vivo experiments
We first performed an ex vivo experiment on swine rectal mucosa to determine the ideal parameters for APC for use in the treatment of radiation proctopathy in humans. The experiment was repeated twice by using the rectums from 2 swine. The results of the 2 experiments were almost identical. Figure 1 shows the macroscopic appearance of swine rectal mucosa coagulated at differing parameters.
Coagulation depths at varying parameters based on histological analysis are summarized in Figure 2. The
Discussion
In this study, we first determined the optimal settings for APC with first-generation APC generators by using swine rectum, and we then treated patients with HRP prospectively to assess the efficacy and safety of APC using the same settings.
Most of the previous studies on HRP were retrospective and were limited by small patient numbers. Our patient series represents one of the largest reported to date and also provides longer term follow-up data compared with other studies.14, 28, 29 We
Acknowledgments
We express our deep appreciation to Dr. Ikeda for his valuable advice on hematoxylin and eosin staining and Elastica van Gieson staining.
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DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.