Endoscopy 2001; 33(3): 210-215
DOI: 10.1055/s-2001-12804
Original Article

© Georg Thieme Verlag Stuttgart · New York

Endoscopic Induction of Mucosal Fibrosis by Argon Plasma Coagulation (APC) for Esophageal Varices: A Prospective Randomized Trial of Ligation plus APC vs. Ligation Alone

S. Nakamura, A. Mitsunaga, Y. Murata, S. Suzuki, N. Hayashi
  • Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
Further Information

Publication History

Publication Date:
31 December 2001 (online)

Background and Study Aims: Esophageal varices are treated by endoscopic ligation with or without sclerotherapy. Here we used argon plasma coagulation (APC) to promote mucosal fibrosis and compared the efficacy of ligation plus APC with ligation alone in the treatment of esophageal varices.

Patients and Methods: Our prospective study included 30 patients with esophageal varices randomly assigned to receive APC after ligation (combined group) and 30 patients assigned to receive ligation only (ligation group). Endoscopic ligation was performed until the varix shrank to F1 without red color sign or smaller. This was followed by induction of fibrosis of the distal esophageal mucosa using APC in the combined group. APC was performed using an argon gas at a flow rate of 1.5 - 2 l/min and a high frequency arc output of 50 - 60 W. Treatment outcome and complications were compared between the two groups.

Results: The mean follow-up time was 18.5 ± 6.8 and 15.8 ± 7.7 months (± SD) for the combined and ligation groups, respectively. The number of treatment sessions was slightly lower in the ligation group (2.9 ± 0.6 vs. 2.5 ± 0.6, P < 0.05). The number of ligation bands used was not different between the two groups (13.4 ± 3.1 vs. 14.9 ± 2.4). The cumulative recurrence-free rate at 24 months after treatment in the combined group was significantly higher than in the ligation group (74.2 % vs. 49.6 %, P < 0.05). A significantly higher incidence of pyrexia was encountered in the combined group (P < 0.05), but the incidences of other complications were similar in both groups.

Conclusion: Our results indicate that endoscopic ligation of esophageal varices combined with APC is superior to ligation alone. Since APC is theoretically well suited for mucosal fibrosis therapy, it can be used for the complete elimination of esophageal varices and for fibrosis of the distal esophageal mucosa.

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S. Nakamura,M.D. 

Institute of Gastroenterology
Tokyo Women's Medical University

8-1 Kawada-cho, Shinjuku-ku
Tokyo 162-8666
Japan

Fax: Fax:+ 81-3-52 697 365

Email: E-mail:shin.n@d5.dion.ne.jp