Abstract
Background and study aims Argon plasma coagulation (APC) is an effective and safe modality for many gastrointestinal
conditions requiring hemostasis and/or ablation. However, it can be quite costly.
A potentially more cost-effective alternative is snare-tip spray coagulation (SC).
This study aimed to determine whether SC would be a safe and effective alternative
to APC using an ex-vivo model.
Methods Using two resected porcine stomach, 36 randomized gastric areas were ablated for 2
seconds with either APC at 1.0 L/min 20 W (APC20) and 1.4 L/min 40 W (APC40) or SC
with Effect 2 60 W (SC60) and 80 W (SC80) from 3 mm. Extent of tissue injury was then
analyzed histopathologically.
Results The mean coagulation depth was 790 ± 159 µm and 825 ± 467 µm for SC60 (n = 9) and
SC80 (n = 8), respectively. This was compared to 539 ± 151 µm for APC20 (n = 8) and
779 ± 267 µm for APC40 (n = 9). Mean difference (MD) in coagulation depth between
SC60 and APC40 was 12 µm (95 % confidence interval [CI], –191 to 214 µm; P = 0.91) and was 47 µm (95 %CI, –162 to 255 µm; P = 0.81) between SC80 and APC40. There was a greater depth of injury with APC40 (MD,
240 µm; 95 %CI, 62 to 418 µm; P = 0.04) and with SC60 (MD, 252 µm; 95 %CI, 141 to 362 µm; P = 0.004) when compared to APC20. Mean cross-sectional area of coagulation was 2.39 ± 0.852
mm² for SC60 and 2.54 ± 1.83 mm² for SC80 compared to 1.22 ± 0.569 mm² for APC20 and
1.99 ± 0.769 mm² for APC40. Seventy-eight percent reached the muscularis mucosa (MM)
and 11 % the submucosa in the SC60 group compared to 50 % and 38 % in SC80 and 56 %
and 11 % in APC40, respectively. Thirty-eight percent of APC20 specimens reached the
MM. The muscularis propria was unaffected.
Conclusions This small ex-vivo study suggests that SC60 and SC80 may be safe alternatives to APC40
with comparable coagulation depths and area effects.
