Authors' objectives:

The purpose of this report is to assess the usefulness of the argon plasma coagulator (APC) in the different uses proposed for gastrointestinal tract pathologies.

Authors' results and conclusions: Eleven studies on APC use for gastrointestinal lesions were found as well as a systematic revision on the topic, updated until July 2003. Adjuvant therapy after colon polyp resection: A randomized control trial (RCT) which included 21 patients with colon polyps greater than 1.5 cm, compared macroscopically complete polypectomy with patients who also received APC in the resected area. There was a lower rate of microscopic recurrence in the APC group (10% vs 64%, p=0.02) at one year. In a quasi-experimenta study, no differences were observed in cases of incomplete polypectomies. Radiation-induced proctitis: The series found show that APC use could be beneficial for the treatment of radiation induced proctitis, reducing the percentage of required transfusions. Vascular lesions: Six case series of vascular lesions were found (vascular ectasia of the gastric antrum, arteriovenous malformation) which also showed a favourable evolution with this technology. Barrett s esophagus: with respect to the treatment of Barrett s esophagus many CRCT show different results: greater lesion reduction with APC (33 of 34 cases) than with photodynamic therapy (17 of 34 cases), but without differences when comparing APC alone versus photodynamic therapy with 5-aminolevulinic acid. It is woth mentioning that in both cases the lesion disappeared completely in only 66% of the subjects; in cases of gastric fundoplications, the lesion was not observed after treatment in 63% of the cases in which APC was used versus 15% that were only followed-up. The series of cases show that in half of the macroscopic disappearances, the subepithelial lesions persisted. With respect to its use for the treatment of exophageal varices, two CRCT were found which showed lower recurrence in patients who underwent APC treatment versus those who were followed-up. There were no differences in recurrence, nor in mortality when compared with other alternatives when used for gastrointestinal bleeding treatment caused by peptic ulcers, with a 1to 2-year follow-up.

Authors' recommendations: The argon plasma coagulator has been used for a number of gastrointestinal pathologies with dissimilar results. Although it has demonstrated certain effect in the short-term for the treatment of colon polyps, esophageal varices, and with less evidence in radiation induced proctitis and vascular lesions, its mid and long term effectiveness and safety is unknown In the case of peptic ulcer treatment, APC has not demonstrated to be better than other less expensive alternatives. On the other hand, with the respect to Barrett s esophagus, studies have not demonstrated complete disappearance of the lesion. Case of microscopic persistence has been found, and the impact that this treatment may have in the development of malignant lesions in the long term is unknown. There was almost no evidence of APC coverage by the health systems assessed. In summary, it is a novel technology that could have a potential benefit for the treatment of some pathologies. However, in most cases only the short-term benefit was studied, with intermediate results of poor clinical relevance and based on evidence of disparate quality. Its mid and long term effectiveness and safety is unknown.

Authors' methods: Overview

Project Status: Completed

URL for project: http://www.iecs.org.ar/

Year Published: 2005

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)