Outcomes post Argon Plasma Coagulation (APC) during Device Assisted Enteroscopy (DAE) in a National Referral Centre

Aims Patients with positive findings at small-bowel capsule endoscopy (SBCE), European Society of Gastroenterology (ESGE) recommends DAE to confirm and possibly treat lesions. This study aims to identify patients with GI bleeds treated with APC during DAE and assess if APC impacted the rate of re-bleeding. Treatment outcomes with APC were investigated and assessed if it impacted the number of repeat endoscopy procedures and transfusion rates. Analysis of ESGE key performance measures (KPMs) was performed.

Methods Retrospective review DAE reports from 2022-2024 was performed. Patient demographics including age, gender, indication for DAE captured. Number of endoscopy procedures 6 months pre and post DAE recorded. Occurrence of re-bleeding evaluated by comparing number of blood transfusions required 6 months pre ' post APC at DAE. Essential KPMs were assessed. Statistical analysis was performed using paired T-Tests to assess for statistical significance.

Results 48 DAEs were included in the final analysis (62.5% male, median age 71.3, range 49-92 years). 46/48 (96%) procedures were anterograde in approach. 3 patients died within 6 months of their DAE. 41/48 (85.4%) had a capsule endoscopy performed prior to DAE. The mean procedure length was 38 minutes (range 13-71 minutes). Conscious sedation is currently used in this centre due to lack of access to a general anaesthetic list. Midazolam (mean dosing 4mg) along with Fentanyl (mean dosing 100mcg) are the choice of agents used. In this cohort, a total of 89 endoscopic interventions were performed prior to DAE (mean 2.0, SD 1.15) compared to 7 (mean 0.15 SD0.36) in the 6 months post endoscopy (p<0.0001). The 7 repeat procedures were 3 DAEs and 4 OGDs. 100 units blood transfusions (mean 2.29, SD 3.1) were required prior to DAE compared to 15 (mean 0.31, SD 0.69), (p=0.0001) after intervention at DAE. 4 patients to commenced Lanreotide (somatostatin analogue) 60mg SC monthly post APC treatment. 4 additional patients were recommended to commence if they presented with a re-bleed (numbers too small to perform analysis). This study reached key performance measures for Indication 100% (aim>95%) Complication Rate 0.78% (aim<5%) Lesion Detection Rate 71.65% (> 50%) and Successful Therapeutic Intervention 84.38% (> 80%).

Conclusions Treatment with APC during DAE statistically significantly reduced the number of endoscopic interventions and blood transfusions required in the six months post DAE. APC at DAE is a successful therapeutic intervention for mid-zone GI bleeding and in the future should be utilised earlier to reduce unnecessary diagnostic endoscopies. More DAE centres are required in Ireland to progress effective diagnostic and therapeutic small bowel endoscopy. Future studies assessing the benefit of Lanreotide should be carried out.

Publication History

Article published online:
27 March 2025