アルゴンプラズマ凝固法：ｉｎ　ｖｉｖｏにおける食道，胃への組織損傷と早期胃食道癌に対する臨床的有用性

DOI 被引用文献1件 参考文献16件
  • 光藤 章二
    京都府立医科大学.大学院医学研究科消化器病態制御学
  • 名越 真理子
    京都府立医科大学.大学院医学研究科消化器病態制御学
  • 辰巳 陽一
    京都府立医科大学.大学院医学研究科消化器病態制御学
  • 坂井 みき
    京都府立医科大学.大学院医学研究科消化器病態制御学
  • 塩見 聡史
    京都府立医科大学.大学院医学研究科消化器病態制御学
  • 若林 直樹
    京都府立医科大学.大学院医学研究科消化器病態制御学
  • 小西 英幸
    京都府立医科大学.大学院医学研究科消化器病態制御学
  • 岡野 均
    京都府立医科大学.大学院医学研究科消化器病態制御学
  • 片岡 慶正
    京都府立医科大学.大学院医学研究科消化器病態制御学
  • 岡上 武
    京都府立医科大学.大学院医学研究科消化器病態制御学

書誌事項

タイトル別名
  • ARGON PLASMA COAGULATION: IN VIVO TISSUE DAMAGE TO THE ESOPHAGUS AND STOMACH AND CLINICAL EFFICACY FOR EARLY ESOPHAGEAL AND GASTRIC CANCER

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Background : Argon plasma coagulation (APC) has proved to be safe in vitro, and has been widely introduced to therapeutic endoscopy. We evaluated the thermal effects on esophageal or gastric wall in vivo, and effectiveness as an adjunct to incomplete resection of early esophageal and gastric cancer after endoscopic mucosal resection (EMR).Methods : Thermal injuries were made using endoscopic APC irradiation in porcine esophagus and stomach under various conditions during general anesthesia, and depth of tissue damage was determined histopathologically. Patients with early gastric cancer (n=24) and early esophageal cancer (n=5) were treated with additional APC following microscopically incom-plete EMR. APC was applied to coagulate the entire edge of EMR-induced ulcer 1 week after resection at power/gas settings of 50 W and 1.5 L/min in the stomach, and 40 W and 1.5 L/min in the esophagus for less than 5 s at each point.Results : Depth of tissue damage was related to pulse duration and power output. At power/gas settings of 60 W and 2.0 L/min, thermal damage extended across the submucosal layer with 5-s pulse duration in the stomach. Thermal damage with 5-s pulse duration at power/gas settings of 40 W and 2.0 L/min extended to the muscularis propria in the esophagus. In the clinical study of additional APC therapy, recurrence rate was 6.9 % (2 of 29 cases).Conclusion : To avoid perforation, we recommend an APC power setting of 40-60 W for less than 5 s in the stomach and a lower power setting with shorter duration in the esophagus. APC seems to reduce recurrence of esophageal or gastric cancer after incomplete EMR.

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