ARGON PLASMA COAGULATION: IN VIVO TISSUE DAMAGE TO THE ESOPHAGUS AND STOMACH AND CLINICAL EFFICACY FOR EARLY ESOPHAGEAL AND GASTRIC CANCER

• Published in: 日本消化器内視鏡学会雑誌 Vol. 48; no. 6; pp. 1259 - 1266
• Main Authors: MITSUFUJI Shoji, NAGOSHI Mariko, TATSUMI Yoichi, SAKAI Miki, SHIOMI Satoshi, WAKABAYASHI Naoki, KONISHI Hideyuki, OKANO Hitoshi, KATAOKA Keisho, OKANOUE Takeshi
• Format: Journal Article
• Language: Japanese
• Published: Japan Gastroenterological Endoscopy Society 01.06.2006; 一般社団法人 日本消化器内視鏡学会
• Subjects: in vivo実験; アルゴンプラズマ凝固法(APC); 内視鏡的粘膜切除術(EMR); 早期胃癌; 早期食道癌
• ISSN: 0387-1207; 0915-5635; 1443-1661; 1884-5738
• DOI: 10.11280/gee1973b.48.1259

Background : Argon plasma coagulation (APC) has proved to be safe in vitro, and has been widely introduced to therapeutic endoscopy. We evaluated the thermal effects on esophageal or gastric wall in vivo, and effectiveness as an adjunct to incomplete resection of early esophageal and gastric cancer after endoscopic mucosal resection (EMR).Methods : Thermal injuries were made using endoscopic APC irradiation in porcine esophagus and stomach under various conditions during general anesthesia, and depth of tissue damage was determined histopathologically. Patients with early gastric cancer (n=24) and early esophageal cancer (n=5) were treated with additional APC following microscopically incom-plete EMR. APC was applied to coagulate the entire edge of EMR-induced ulcer 1 week after resection at power/gas settings of 50 W and 1.5 L/min in the stomach, and 40 W and 1.5 L/min in the esophagus for less than 5 s at each point.Results : Depth of tissue damage was related to pulse duration and power output. At power/gas settings of 60 W and 2.0 L/min, thermal damage extended across the submucosal layer with 5-s pulse duration in the stomach. Thermal damage with 5-s pulse duration at power/gas settings of 40 W and 2.0 L/min extended to the muscularis propria in the esophagus. In the clinical study of additional APC therapy, recurrence rate was 6.9 % (2 of 29 cases).Conclusion : To avoid perforation, we recommend an APC power setting of 40-60 W for less than 5 s in the stomach and a lower power setting with shorter duration in the esophagus. APC seems to reduce recurrence of esophageal or gastric cancer after incomplete EMR. 【背景】アルゴンプラズマ凝固法(APC)はin vitroでは安全であることが証明され,内視鏡的治療に広く導入されるようになってきた.われわれはAPCの食道壁および胃壁へのin ivivoでの熱焼灼効果と,早期胃食道癌の内視鏡的粘膜切除術(EMR)後の不完全切除例に対する追加治療としての有用性を評価した.【方法】全身麻酔下でブタの食道,胃に内視鏡的APC照射を行い,熱損傷を作成して病理組織学的に組織損傷の深度を判定した.また,EMRを行い組織学的不完全切除と判定された早期胃癌24例と早期食道癌5例に追加APC治療を行った.切除一週間後に,EMR後潰瘍の辺縁を全周性にAPCで焼灼した.設定条件は胃では出力50W,流量1.5L/分,食道では40W,1.5L/分で,照射時間は各点5秒未満とした.【結果】組織損傷の深度は,照射時問と出力に関連していた.胃では出力60W,流量2.0L/分,照射時間5秒で,熱損傷は粘膜下層全層に及んでいた.食道では出力40W,流量2.OL/分,照射時間5秒で焼灼深度は固有筋層に達していた.追加APC治療の臨床研究では,再発率6.9%(29例中2例)であった.【結論】穿孔を防ぐために,APCの出力設定は胃では40-60Wで照射時間5秒未満が,食道ではさらに低出力,短時間照射が推奨される.早期胃食道癌のEMRにおいて,不完全切除例に対する迫加APC治療は,その再発率を減少させるものと考えられた.