Argon plasma coagulation is safe and effective for treating smaller gastric lesions with low-grade dysplasia: a comparis
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and Other Interventional Techniques
Argon plasma coagulation is safe and effective for treating smaller gastric lesions with low-grade dysplasia: a comparison with endoscopic submucosal dissection Se Jin Jung • Soo-Jeong Cho • Il Ju Choi • Myeong-Cherl Kook • Chan Gyoo Kim • Jong Yeul Lee • Sook Ryun Park • Jun Ho Lee Keun Won Ryu • Young-Woo Kim
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Received: 3 June 2012 / Accepted: 3 September 2012 / Published online: 18 October 2012 Ó Springer Science+Business Media New York 2012
Abstract Background and aims The best therapeutic modality has not been established for gastric low-grade adenomas or dysplasia (LGD), which can progress to invasive carcinoma despite a low risk. This study aims to investigate the clinical efficacy, safety, and local recurrence after argon plasma coagulation (APC) treatment of gastric LGD compared with endoscopic submucosal dissection (ESD). Patients and methods A total of 320 patients with gastric LGD B2.0 cm treated with APC or ESD between 2004 and 2011 were retrospectively analyzed. We compared local recurrence rate, complication rate, procedure time, and admission to hospital between APC and ESD groups. Results Of the 320 patients, 116 patients were treated with APC and 204 with ESD. During follow-up, local recurrence was more common in the APC group (3.8 %, 4/106) than the ESD group (0.5 %, 1/188; log-rank test P = 0.036). However, all patients with local recurrence (n = 5) were treated by additional APC, and followed up without further recurrences. ESD was complicated by two perforations (1.0 %, 2/204) compared with no perforations in the APC group (0 %, 0/116). Bleeding complications were not different between the APC (1.7 %, 2/116) and ESD (2.0 %, 4/204) groups. Procedure time was shorter in the APC (7.8 ± 5.1 min) than the ESD (53.1 ± 38.1 min) group (P \ 0.001). The proportion of hospitalization was
S. J. Jung S.-J. Cho (&) I. J. Choi M.-C. Kook C. G. Kim J. Y. Lee S. R. Park J. H. Lee K. W. Ryu Y.-W. Kim Center for Gastric Cancer, National Cancer Center, 111 Jungbalsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Republic of Korea e-mail: [email protected]
less in the APC group (31.0 %, 36/116) than the ESD group (100.0 %, 204/204) (P \ 0.001). Conclusions APC can be a good treatment option for patients with LGD B2.0 cm. Keywords Low-grade adenoma/dysplasia Argon plasma coagulation Endoscopic submucosal dissection Abbreviations APC Argon plasma coagulation EGD Esophagogastroduodenoscopy EMR Endoscopic mucosal resection ESD Endoscopic submucosal dissection HGD High-grade dysplasia LGD Low-grade dysplasia
Gastric adenoma or dysplasia is a precursor lesion of gastric cancer usually classified using a two-grade system into low-grade dysplasia (LGD) and high-grade dysplasia (HGD) [1–3]. Gastric HGD has a significant risk of progression and containing cancer. Therefore, endoscopic resection is regarded as the best treatment for gastric HGD [4–7]. However, although gastric LGD carries some risk of disease progression, it is less progressive than HGD [
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