Argon Plasma Coagulation In Treatment Of Esophageal Lesions Of Safety Research

Research backgroundEsophageal disease is not uncommon in clinical, argon plasma coagulation(APC) is anon-contact, based on the diathermy treatment technology. In1991by the German doctorGrund [1] for the first application of APC on endoscopic treatment, and achieved satisfac-tory results. It has safety, high efficiency, simple operation, accurate positioning,effect ofparameters adjustment, direct observation, wound healing,ect. In recent years, APC iswidely used in the treatment of digestive tract proliferative lesions. Clinical findings thatAPC one-time treatment esophageal of t he week type lesions, it often can cause esophagealstenosis, but the study of this phenomenon is not much. At present, with more experience toprevent complications. In the application of APC reports of treatment of esophageal lesions[2-4], they more emphasis on power output adjust ed to60w or below60w.The research ofChaoqian Fan [5] have shown that the power is controled below70w at the time of treat-ment of upper gastrointestinal bleeding in APC. But they have not given the correspondingbasis. Therefore,it is very important of l ooking for APC root cause of esophageal strictureand scar hyperplasia and effective solution, to reduce the risk of esophageal stricture aftertreatment APC.The aim of this study is the relationship between APC different output power, argongas flow and action time and the esophageal damage degree; the relationship between eso-phageal tissue damage and scar hyperplasia and and the esophageal stenosis our domesticdogs as experimental animals.It is provided experimental basis for APC clinical safety.ObjectiveThe purpose of this study was to study impact of different output parameters of argonplasma coagulation equipment on esophageal injury in vivo dogs, explore safe range ofAPC treatment to esophageal diseases. Methods1. Esophageal mucosa of three vivo dogs was solidified with argon plasma coagulation,using different output power (50W,60W,70W,80W), argon flow (1.6L/min,2.0L/min,2.4L/min) and acting time (2s,4s). After slicing and HE staining, we observed the depth oftissue damage with an optical microscope.2. Esophageal mucosa of two vivo dogs was solidified with argon plasma coagulation,using argon flow of2.0L/min, acting time of3s and different output power (50W,60W,70W,80W,90W,100W). After slicing and HE staining, we observed the depth of tissue dam-age with an optical microscope.3. Eight vivo dogs were randomly divided into two groups. Esophageal mucosa thatforty centimeters away from incisor was annularly burned, using output power of60Wand70W. The mucosal scar formation and esophageal stenosis was observed by the gastro-scope and ultrasound gastroscope after two and four weeks.Results1. Esophageal tissue damage depth was positively correlated with the output power,argon flow and acting time. Of which, power change had the greatest impact on the depth ofdamage. At the same of the argon gas flow and action time, there is a corresponding rela-tionship between output power and esophageal injury depth.2. In conditions of fixed argon flow and acting time, pathological score of esophagealtissue damage increased with the rise of power. There is a corresponding relationship be-tween output power and esophageal injury depth. Within the range of50W to70W, With theincrease of output power, tissue damage depth increases rapidly.Within the range of70W to90W, the variation of tissue injury was not significant with the power change. Within therange of90W to100W, With the increase of output power, tissue damage depth increasesrapidly again.3. After two and four weeks, the scar formation and esophageal stenosis in esophagealinjury site was observed with the APC output parameter of70W (2L、3s). Howerer, the scarformation and esophageal stenosis was not obvious with the APC output parameter of60W(2L、3s).Conclusion1. There is a positive correlation relationship between esophageal tissue damage depthand APC3output parameters. Of which, power change in10w increase had the greatest impact on the depth of damage.2. Within a certain range of output power, APC to tissue injury has certainself-limited, but more than the scope self-limited is not obvious.3. In conditions of fixed argon flow and acting time, there is a positive correlation re-lationship between esophageal tissue damage depth and output power.4. It can be adjusted by APC output parameters to achieve the purpose of control APCon the depth of esophageal tissue damage.5. Esophageal tissue damage level is associated with esophageal stenosis and eso-phageal scar hyperplasia, when the damage of submucosal and muscular shallow, it can leadto significant esophageal stricture and scar hyperplasia.