Prospective evaluation of a new mode of the VIO 300D-Argon-Plasma-Coagulation (APC)-system for coagulation of gastrointestinal angiodysplasias: Effectivity and safety of PRECISE APC

Aims: The coagulation effect of endoscopic thermal techniques for the treatment of gastrointestinal angiodysplasias has been proven for years. APC is a thermal coagulation technique that uses ionized argon to transmit high-frequency electrical current, contact free, to tissue. However, data from the new APC -VIO -300D -system with amplified power settings and different application modes is lacking. Precise APC is one of the new modes and characterized by a small and distinctive energy input, higher reproducibility of tissue effects which is almost independent of the probe distance. The maximum depth of coagulation is only 1.5mm and therefore a better depth control is achieved especially in thin structures like cecum or duodenum. The aim of the study was the evaluation of precise APC in patients with bleeding angiodysplasias in the cecum or the small bowel (via single-balloon enteroscopy).

Aim/methods: Patients (pts.) with bleeding angiodysplasia of cecum or small bowel were prospectively enrolled in the study. Effectivity and safety of APC was assessed by evaluating local coagulation effect, number of rebleedings and transfusions and complications (perforation, infection). The energy output is adjusted in effect levels (effect 1=low energy output until effect 10=high energy output). A total number of 94 pts. were included.

Results: There were 50 male and 44 female, median age 65.5±8.1 years. Median precise APC energy effect was 6.2±1.5. 58 pts. (62%) had lesions in the small bowel, 28 pts. (30%) lesions in the cecum and 8 pts. (8%) lesions in small bowel and cecum. All 234 visible lesions in 94 pts. were coagulated successfully. There was no perforation, active bleeding and tissue carbonisation after the procedure. Mild infection (fever) was noted in 6 pts. (6%). Re-bleeding was recognized in 18 pts. (19%) after a mean follow-up of 5.1 months and new lesions in the same area were seen in 15/18 pts (16%).

Conclusion: In comparison to forced or pulsed APC, precise APC seems to be a more appropriate option for the treatment of bleeding angiodysplasias in crucial locations like cecum or small bowel. The coagulation effect is comparable and due to its better depth control we assume a higher safety, especially in preventing perforations.