1. Can argon plasma coagulation be endoscopic recovery treatment in uncontrolled esophageal varices bleeding?
Hüseyin Sancar BOZKURT
Gastroenterology,MD
Medical Park Private Tarsus Hospital/MERSİN/TURKEY

2. Esophageal variceal bleeding is a life-threatening complication of portal hypertension with a six-week mortality rate of approximately 20%. The available data suggest that vasoactive drugs, combined with endoscopic therapy and antibiotics, are the best treatment strategy with endoscopic variceal ligation(EVL) being the endoscopic procedure of choice.

5. Tissue adhesives, endoloops, endoscopic clipping and argon plasma coagulation(APC), have been used in the management of uncontrolled esophageal varices bleeding.

8. ARGON PLASMA COAGULATİON
APC induces coagulation of the tissue surface through the use of a high-frequency monopolar electrical current conducted via ionized argon gas. The depth of penetration usually ranges from 1 to 3 mm but may reach 6 mm by varying the power, distance, gas flow, and duration of treatment, thus the risk for esophageal perforation is less… 
It is a noncontact method delivered via the accessory channel of the endoscope. The major benefit of this technique is that it is a quick method of therapy deliverable over a large treatment area

9. ARGON PLASMA COAGULATİON
The principle of APC is that high-frequency monopolar current is conducted to target tissues through ionized argon gas (argon plasma). Argon gas passes through the coagulation probe with an electrode at its tip. The foot switch activates the electrode. Electrons flow through the channel of electrically activated ionized argon gas from the probe to the tissue.  The arrival of the current density at the tissue surface results in coagulation. 

10. ARGON PLASMA COAGULATİON
Therapy is performed for hemostasis of superficial vascular ectasias such as GAVE for hemostasis of peptic ulcers, and for tissue ablation
APC used for as an ablative technique in Barret esophagus,dysplasia and malignant lesions

15. The theoretical advantages of APC include its ease of application, speedy treatment of multiple lesions in the case of angiodysplasias or wide areas (the base of resected polyps or tumor bleeding), safety due to reduced depth of penetration, and lower cost compared to laser.

16. We reported two cases 77-year-old man with hepatitis C ,Child-Pugh B cirrhosis who received EVL for esophageal variceal haemorrhage two years ago and 47 –year old man with alcohol induced Child-Pugh C cirrhosis who received EVL for esophageal variceal haemorrhage one year ago included with uncontrolled esophageal varices bleeding

17. Argon plasma coagulation has been used as a recovery treatment for controlling of acute esophageal varices bleeding after unsuccesful endoscopic sclerotheraphy and EVL .The bleeding was controlled succesfully in patients.

19. Acute esophageal varices bleeding

20. Bleeding was controlled after APC

22. ARGON PLASMA COAGULATİON
●Targeted therapy of isolated angiodysplasia in the colon, small bowel, and stomach.
●Treatment of gastric antral vascular ectasia.
●Treatment of radiation telangiectasia (also referred to as radiation proctopathy or radiation proctitis) with significant or symptomatic bleeding.
●Postpolypectomy for large sessile polyps to fulgurate the base to reduce recurrent adenoma.
●Ablation of flat residual duodenal or colon polyps in hard to reach locations that cannot be removed with a snare.
●Treatment of tumor ingrowth into esophageal metal stents.

23. Argon plasma coagulation is safety usually and it can be endoscopic recovery treatment in uncontrolled esophageal varices bleeding.