Fetz Andrew, Farnell David, Irani Shayan, Gan S Ian
Gastroenterology Department, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.
Pathology Department, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.
Endosc Int Open. 2021 Jun;9(6):E790-E795. doi: 10.1055/a-1373-4162. Epub 2021 May 27.
Argon plasma coagulation (APC) is an effective and safe modality for many gastrointestinal conditions requiring hemostasis and/or ablation. However, it can be quite costly. A potentially more cost-effective alternative is snare-tip spray coagulation (SC). This study aimed to determine whether SC would be a safe and effective alternative to APC using an ex-vivo model. Using two resected porcine stomach, 36 randomized gastric areas were ablated for 2 seconds with either APC at 1.0 L/min 20 W (APC20) and 1.4 L/min 40 W (APC40) or SC with Effect 2 60 W (SC60) and 80 W (SC80) from 3 mm. Extent of tissue injury was then analyzed histopathologically. The mean coagulation depth was 790 ± 159 µm and 825 ± 467 µm for SC60 (n = 9) and SC80 (n = 8), respectively. This was compared to 539 ± 151 µm for APC20 (n = 8) and 779 ± 267 µm for APC40 (n = 9). Mean difference (MD) in coagulation depth between SC60 and APC40 was 12 µm (95 % confidence interval [CI], -191 to 214 µm; = 0.91) and was 47 µm (95 %CI, -162 to 255 µm; = 0.81) between SC80 and APC40. There was a greater depth of injury with APC40 (MD, 240 µm; 95 %CI, 62 to 418 µm; = 0.04) and with SC60 (MD, 252 µm; 95 %CI, 141 to 362 µm; = 0.004) when compared to APC20. Mean cross-sectional area of coagulation was 2.39 ± 0.852 mm² for SC60 and 2.54 ± 1.83 mm² for SC80 compared to 1.22 ± 0.569 mm² for APC20 and 1.99 ± 0.769 mm² for APC40. Seventy-eight percent reached the muscularis mucosa (MM) and 11 % the submucosa in the SC60 group compared to 50 % and 38 % in SC80 and 56 % and 11 % in APC40, respectively. Thirty-eight percent of APC20 specimens reached the MM. The muscularis propria was unaffected. This small ex-vivo study suggests that SC60 and SC80 may be safe alternatives to APC40 with comparable coagulation depths and area effects.
氩等离子体凝固术（APC）是一种用于许多需要止血和/或消融的胃肠道疾病的有效且安全的治疗方式。然而，其成本可能相当高。一种潜在更具成本效益的替代方法是圈套器顶端喷雾凝固术（SC）。本研究旨在使用离体模型确定SC是否是APC的一种安全有效的替代方法。使用两个切除的猪胃，将36个随机选择的胃区域分别用1.0升/分钟20瓦的APC（APC20）、1.4升/分钟40瓦的APC（APC40）、60瓦的Effect 2的SC（SC60）以及80瓦的Effect 2的SC（SC80）从3毫米处进行2秒的消融。然后对组织损伤程度进行组织病理学分析。SC60组（n = 9）和SC80组（n = 8）的平均凝固深度分别为790±159微米和825±467微米。与之相比，APC20组（n = 8）为539±151微米，APC40组（n = 9）为779±267微米。SC60与APC40之间凝固深度的平均差值（MD）为12微米（95%置信区间[CI]，-191至214微米；P = 0.91），SC80与APC40之间为47微米（95%CI，-162至255微米；P = 0.81）。与APC20相比，APC40（MD，240微米；95%CI，62至418微米；P = 0.04）和SC60（MD，252微米；95%CI，141至362微米；P = 0.004）造成的损伤深度更大。SC60的平均凝固横截面积为2.39±0.852平方毫米，SC80为2.54±1.83平方毫米，与之相比，APC20为1.22±
