Safety and feasibility of argon plasma coagulation for gastric low-grade dysplasia: a systematic review and meta-analysis.

BACKGROUND AND AIMS

Gastric low-grade dysplasia (LGD), as precancerous lesions, carry a risk of progressing to carcinoma, particularly in elderly or high-risk patients. Standard treatments like endoscopic submucosal dissection (ESD) can be technically challenging and risky. Argon plasma coagulation (APC) has emerged as a less invasive alternative with shorter procedural times but potentially higher local recurrence rates. This review evaluates the safety and feasibility of APC for managing gastric LGD.

METHODS

A systematic review following PRISMA guidelines included studies from MEDLINE, Embase, CINAHL, and Cochrane Library on APC for gastric LGD. Data on recurrence, bleeding, perforation, and procedural time were analyzed through meta-analysis.

RESULTS

From 3409 studies, 10 met inclusion criteria. APC showed a recurrence rate of 4.5% (54/1208), with a pooled OR of 6.96 (95% CI 1.13-42.86, P = 0.95, I = 0%) compared to ESD. The 5-year recurrence rate was 6.4%. Post-procedural bleeding was reported in 1.4% (18/1242) of cases, and one perforation case overall. Procedure times ranged from 7.8 to 15.5 min. Recurrence risk was significantly lower for lesions < 1.0 cm (pooled HR 0.28, 95% CI 0.13-0.59, P = 0.92, I = 0%).

CONCLUSION

APC is a safe and efficient option for treating gastric LGD in selected patients, with shorter procedural times and low rates of complications. However, its higher recurrence risk for larger lesions highlights the need for careful patient selection and further research.