ARGON PLASMA COAGULATION: IS IT SAFE WHEN MANAGED AS A HIGH BLEEDING RISK PROCEDURE?

Aims Argon plasma coagulation (APC) is an ablative therapy used for a wide variety of indications throughout the gastrointestinal tract. There are no data on continued use of antithrombotics with respect to the risk of bleeding after APC. Therefore, current ESGE guideline does not provide any guidance in this regard. This study aimed to assess post-procedure bleeding risk and to identify its risk factors.

Methods Multicentre retrospective cohort study including consecutive patients submitted to APC between November/2019 and November/2021. Antithrombotic therapy was managed as a high-risk procedure. Clinically significant post-procedure bleeding: haemoglobin value fall>2g/dL, blood transfusion or unplanned hospital admission.

Results Included 121 procedures in 99 patients [male:67 (67.8%); median age: 76 (68-80) years]. The main indications for APC were angiodysplasia (62%) and radiation proctopathy (38%) and median power used was 35 (25-40) watts. A total of 35 (36%) patients were under antithrombotic therapy (antiplatelet agents- 17%; anticoagulants- 19%). Post-APC bleeding was reported in 5 procedures (4%). Bleeding was clinically significant in 3 of the 5 cases and was successfully treated in all events with clips with or without adrenaline. In multivariate analysis, risk factors for post-APC bleeding were anticoagulant therapy (OR: 3.5; 95% CI: 1.1-30) and power<20 watts (OR: 12; 95% CI: 1.1-99). Antiplatelet agents use was not associated with post-APC bleeding (P=0.172).

Conclusions Post-APC bleeding was reported in 4% of cases, being higher for patients under anticoagulant therapy and lower APC power. Our results favour APC classification as a high-risk procedure for bleeding.

Publication History

Article published online:
14 April 2022