Endoscopy Division, Cancer Institute, University of São Paulo, São Paulo, Brazil.
United European Gastroenterol J. 2016 Feb;4(1):49-54. doi: 10.1177/2050640615590303. Epub 2015 Jun 9.
The endoscopic use of argon plasma coagulation (APC) to achieve hemostasis for upper gastrointestinal tumor bleeding (UGITB) has not been adequately evaluated in controlled trials. This study aimed to evaluate the efficacy of APC for the treatment of upper gastrointestinal bleeding from malignant lesions.
Between January and September 2011, all patients with UGITB underwent high-potency APC therapy (up to 70 Watts). This group was compared with a historical cohort of patients admitted between January and December 2010, when the endoscopic treatment of bleeding malignancies was not routinely performed. Patients were stratified into two categories, grouping the Eastern Cooperative Oncology Group (ECOG) performance status scale: Category I (ECOG 0-2) patients with a good clinical status and Category II (ECOG 3-4) patients with a poor clinical status.
Our study had 25 patients with UGITB whom underwent APC treatment and 28 patients whom received no endoscopic therapy. The clinical characteristics of the groups were similar, except for endoscopic active bleeding, which was more frequently detected in APC group. We had 15 patients in the APC group whom had active bleeding, and initial hemostasis was obtained in 11 of them (73.3%). In the control group, four patients had active bleeding. There were no differences in 30-day re-bleeding (33.3% in the APC group versus 14.3% in the control group; p = 0.104) and 30-day mortality rates (20.8% in the APC group, versus 42.9% in the control group; p = 0.091). When patients were categorized according to their ECOG status, we found that APC therapy had no impact in re-bleeding and mortality rates (Group I: APC versus no endoscopic treatment: re-bleeding p = 0.412, mortality p = 0.669; Group II: APC versus no endoscopic treatment: re-bleeding p = 0.505, mortality p = 0.580). Hematemesis and site of bleeding located at the esophagus or duodenum were associated with a higher 30-day mortality.
Endoscopic hemostasis of UGITB with APC has no significant impact on 30-day re-bleeding and mortality rates, irrespective of patient performance status.
氩等离子凝固（APC）在内镜下用于治疗上消化道肿瘤出血（UGITB），尚未在对照试验中得到充分评估。本研究旨在评估 APC 治疗上消化道恶性病变出血的疗效。
2011 年 1 月至 9 月期间，所有 UGITB 患者均接受高功率 APC 治疗（最高 70 瓦）。该组与 2010 年 1 月至 12 月期间入院、内镜治疗出血性恶性肿瘤不常规进行的历史队列患者进行比较。患者分为两组，按东部肿瘤协作组（ECOG）体力状态评分分层：Ⅰ类（ECOG 0-2）患者临床状况良好，Ⅱ类（ECOG 3-4）患者临床状况差。
我们的研究共有 25 例 UGITB 患者接受 APC 治疗，28 例患者未接受内镜治疗。两组的临床特征相似，除了 APC 组更常检测到内镜下活动性出血。APC 组有 15 例患者有活动性出血，其中 11 例（73.3%）获得了初始止血。对照组有 4 例患者有活动性出血。30 天再出血率（APC 组 33.3%与对照组 14.3%；p=0.104）和 30 天死亡率（APC 组 20.8%，对照组 42.9%；p=0.091）无差异。当根据 ECOG 状态对患者进行分类时，我们发现 APC 治疗对再出血和死亡率无影响（Ⅰ组：APC 与无内镜治疗：再出血率 p=0.412，死亡率 p=0.669；Ⅱ组：APC 与无内镜治疗：再出血率 p=0.505，死亡率 p=0.580）。呕血和出血部位位于食管或十二指肠与 30 天死亡率较高相关。
内镜下用 APC 治疗 UGITB 对 30 天再出血和死亡率无显著影响，与患者的体能状态无关。
