Estifan Elias, Cavanagh Yana, Grossman Matthew A
Internal Medicine, St. Joseph's University Medical Center, Paterson, USA.
Interventional Gastroenterology, St. Joseph's University Medical Center, Paterson, USA.
Cureus. 2020 Mar 26;12(3):e7427. doi: 10.7759/cureus.7427.
Hybrid argon plasma coagulation (HybridAPC® [HAPC]) is an evolution of the standard argon plasma coagulation (APC) technology, where the application of APC is preceded by high-pressure needleless submucosal injection. APC is indicated for the ablation of benign and dysplastic mucosal lesions, such as vascular malformations or Barrett's mucosa. HAPC offers safety and efficacy advantages over standard APC because the submucosal injection acts as a heat sink that disperses energy. This ensures that the underlying muscularis propria remains unaffected, and only the mucosal layer is coagulated in its entirety. An 81-year-old Hispanic male was found to have a 1.2-cm mucosal nodule along the incisura of the stomach. Pathology of the biopsy specimen revealed high-grade dysplasia, and he subsequently underwent endoscopic ultrasound examination, which confirmed the presence of an isolated gastric nodule with no deep invasion of the muscularis propria, consistent with a uT1N0Mx endosonographic staging. He then underwent endoscopic submucosal dissection of the lesion. Pathology of the excised specimen confirmed the presence of multifocal high-grade dysplasia, arising in the background of extensive intestinal metaplasia. The deep margin was clear; however, the lateral resection margins showed focal involvement of intestinal metaplasia with low-grade dysplasia. Surveillance endoscopy confirmed the persistence of diffuse intestinal metaplasia. He was then treated with widespread HAPC due to the presence of underlying diffuse intestinal metaplasia in the stomach. HAPC is an effective and efficient treatment modality for mucosal lesions. In one series of 50 patients, 96% achieved complete macroscopic remission of Barrett's mucosa after a median of 3.5 APC sessions, and 85% achieved complete histological remission. HAPC is a promising therapeutic modality as a thermal injury is targeted, and the depth of injury is contained. This provides immediate procedural efficacy and safety benefits, and reduces subsequent complications when compared with standard APC. We anticipate that the applications of HAPC will continue to grow, as this modality is adopted into common procedural parlance. This case appears to be the first to describe the use of HAPC for definitive treatment of diffuse intestinal metaplasia.
混合氩等离子体凝固术（HybridAPC® [HAPC]）是标准氩等离子体凝固术（APC）技术的一种改进，在应用APC之前先进行高压无针黏膜下注射。APC适用于消融良性和发育异常的黏膜病变，如血管畸形或巴雷特黏膜。HAPC比标准APC具有安全性和有效性优势，因为黏膜下注射起到了散热作用，能分散能量。这确保了深层固有肌层不受影响，仅黏膜层被完全凝固。一名81岁的西班牙裔男性被发现胃切迹处有一个1.2厘米的黏膜结节。活检标本的病理显示为高级别发育异常，随后他接受了内镜超声检查，证实存在一个孤立的胃结节，无固有肌层的深层侵犯，符合超声内镜分期uT1N0Mx。然后他接受了病变的内镜黏膜下剥离术。切除标本的病理证实存在多灶性高级别发育异常，发生于广泛肠化生的背景下。深部切缘清晰；然而，外侧切除切缘显示肠化生伴低级别发育异常的局灶性累及。监测内镜证实弥漫性肠化生持续存在。由于胃内存在潜在的弥漫性肠化生，他随后接受了广泛的HAPC治疗。HAPC是治疗黏膜病变的一种有效且高效的治疗方式。在一组50例患者中，96%在中位3.5次APC治疗后实现了巴雷特黏膜的完全宏观缓解，85%实现了完全组织学缓解。HAPC是一种有前景的治疗方式，因为它针对热损伤，且损伤深度可控。与标准APC相比，这提供了即时的操作有效性和安全性益处，并减少了后续并发症。我们预计HAPC的应用将持续增加，因为这种方式已被纳入常见的操作术语中。该病例似乎是首例描述使用HAPC确定性治疗弥漫性肠化生的病例。
