Fluid cushion protects against thermal damage during argon plasma coagulation

Objective: Long exposure of argon plasma coagulation (APC) causes thermal damage and apoptosis in tissues. However, whether the APC-induced thermal damage in tissues involves the expression of NF-κB and caspase-3 remains undetermined. In this study, we compared the effect of APC on liver damage at two different exposure time and tested the hypothesis that thermal injuries induced by APC are accompanied by induction of NF-κB and caspase-3 expression in rat liver.Material and Methods: Liver injuries were induced in rats by an APC device with pulse mode for 2 or 4 seconds under the same frequency of power (40W). The animals were sacrificed 0, 3, 7 and 21 days after injury and the liver tissues were harvested and used for western blotting, histological and immunohistochemical analyses.Results: Haematoxylin and eosin (H&E) stained sections of the liver tissues showed that two-second application of APC caused minimum thermal damage and apoptotic areas, less carbonization, and more fibrosis formation in liver than the four-second APC application at all time points examined. All of these APC-induced thermal effects and morphological changes in the two-second APC application group but not the four-second APC application group recovered 21 days after the treatment. Western blot results indicated that APC induced the expression of NF-κB on day 3, and peaked on days and 14. In the two-second APC application group, the expression of NF-κB returned to the normal level on day 28. However, the expression of NF-κB induced by 4 seconds of APC application remained high even 28 days after injury. The expression of caspase-3 induced by the 2 seconds or 4 seconds of APC application peaked at 7 or 14 days, respectively. Similarly, the APC-induce expression of caspase-3 returned to the normal level in the 2-second APC application group, but it still remained high in the 4-second APC application group even 28 days after injury. These results were further confirmed by The immunofluorescence data also indicated that APC exposure for 4 seconds induced a much higher expression of NF-κB than APC exposure for 2 seconds. The similar pattern was observed in the caspase-3 expression.Conclusions: Taken together, our results show that 2-second APC exposure causes minimum liver injury accompanied by the expressions of NF-κB and casapase-3 which return to the normal level 28 days after injury. These findings strongly suggest that the shortest pulse mode (2 seconds) application of APC is a safe, convenient, and effective approach for the treatment of particularly thermosensitive tissues.

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A145 A SUBMUCOSAL FLUID CUSHION PREVENTS MUSCLE LAYER DAMAGE DURING ARGON PLASMA COAGULATION

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwz047.144 ◽

2020 ◽

Vol 3 (Supplement_1) ◽

pp. 8-9

Author(s):

P J Belletrutti ◽

R Maselli ◽

T Stabler ◽

M D Enderle ◽

A Repici

Keyword(s):

Normal Saline ◽

Thermal Damage ◽

Argon Plasma Coagulation ◽

Argon Plasma ◽

Muscle Layer ◽

Tissue Temperature ◽

Final Temperature ◽

Injection Volume ◽

Plasma Coagulation ◽

Significant Difference

Abstract Background Thermal damage to the muscle layer of the gastrointestinal wall can occur during mucosal application of argon plasma coagulation (APC). This injury may be mitigated by creating a fluid cushion within the submucosal layer that physically separates the mucosa from the muscle layer and suppresses unwanted tissue temperature elevation. This in turn protects the muscle layer from thermal damage. The coagulative threshold of muscle proteins is known to be about 60°C, but there are no published systematic assessments of the minimum injection volume needed nor the ideal injectate to prevent thermal damage to the muscle layer during mucosal APC ablation. Aims Our aims were, firstly, to measure the final temperature inside the fluid cushion after mucosal ablation with APC and then to determine any differences in the final temperature between various injectable solutions. Secondly, we sought to determine the minimum volume of injectate required to protect the muscle layer from thermal damage. Methods All experiments were performed in an ex-vivo porcine gastrointestinal tract model. Five different fluids (normal saline, Glyceol, Gelafundin, Voluven and Eleview) of different volumes (range 0 - 5mL) were injected into the submucosa of the esophagus, stomach (fundus) and rectum to create a fluid cushion. APC was applied to the mucosa for a fixed duration (3s) at different power settings (ranging from 30 - 120W). Immediately after APC treatment, the final temperature was measured by placing a contact thermometer inside the fluid cushion, just on top of the muscle layer. Results There was no significant difference in the temperature measured at the surface of the muscle layer between elevation with normal saline, Glyceol, Gelafundin, Voluven and Eleview at all 3 tissue locations at equal injection volumes and power settings. The experiments showed that the temperature rose for each injectate with heightened power settings but also decreased with increasing volume of injected fluid. The minimum amount of fluid needed to protect the muscle layer from thermal damage was 2mL for the esophagus, stomach and rectum in the case of a power setting between 30 to 90W and 3mL in the case of 90 to 120W. Conclusions Normal saline and four commercially available submucosal injectates possess similar thermoregulatory effects as an insulator of the muscle layer during APC treatment. As opposed to the choice of injectate or anatomic location treated, the volume of fluid injected is the main determinant of the final temperature at the level of the muscularis propria. To reduce the likelihood of thermal damage to deeper layers of the GI tract when APC is applied, a minimum injection volume of 2mL is recommended if <90W of power is utilized. Funding Agencies None

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The efficacy and safety of argon plasma coagulation in the management of polyps remnants in stomach and colon

Gastroenterology ◽

10.1016/s0016-5085(01)81276-2 ◽

2001 ◽

Vol 120 (5) ◽

pp. A258-A258

Author(s):

B NENEMAN ◽

G BOMBSKI ◽

E MALECKAPANAS

Keyword(s):

Argon Plasma Coagulation ◽

Argon Plasma ◽

Efficacy And Safety ◽

Plasma Coagulation

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Endoscopic mucosal resection for recurrent gastric antral vascular ectasia

VASA ◽

10.1024/0301-1526.37.3.289 ◽

2008 ◽

Vol 37 (3) ◽

pp. 289-292 ◽

Cited By ~ 5

Author(s):

Katsinelos ◽

Chatzimavroudis ◽

Katsinelos ◽

Panagiotopoulou ◽

Kotakidou ◽

...

Keyword(s):

Endoscopic Mucosal Resection ◽

Argon Plasma Coagulation ◽

Argon Plasma ◽

Deficiency Anemia ◽

Gastric Antral Vascular Ectasia ◽

Therapeutic Approaches ◽

Plasma Coagulation ◽

Vascular Ectasia ◽

Mucosal Resection ◽

First Case

Gastric antral vascular ectasia (GAVE) is an overt or occult source of gastrointestinal bleeding. Despite several therapeutic approaches have been successfully tested for preventing chronic bleeding, some patients present recurrence of GAVE lesions. To the best of our knowledge, we report the first case, of a 86-year-old woman who presented severe iron-deficiency anemia due to GAVE and showed recurrence of GAVE lesion despite the intensive argon plasma coagulation treatment. We performed endoscopic mucosal resection of bleeding GAVE with resolution of anemia.

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