Endoscopy 2004; 36(12): 1085-1088
DOI: 10.1055/s-2004-826033
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Efficacy of Argon Plasma Coagulation in Nonvariceal Upper Gastrointestinal Bleeding

M.  Kanai1 , A.  Hamada1 , Y.  Endo1 , Y.  Takeda1 , M.  Yamakawa1 , H.  Nishikawa1 , A.  Torii1
  • 1Center for Gastrointestinal Endoscopy, Kyoto Katsura Hospital, Kyoto, Japan
Further Information

Publication History

Submitted 21 March 2004

Accepted after Revision 11 August 2004

Publication Date:
01 December 2004 (online)

Background and Study Aims: Various methods of endoscopic hemostasis have been described. However, few reports have investigated the efficacy of argon plasma coagulation (APC) in the treatment of upper gastrointestinal bleeding. The aim of this study was to evaluate the efficacy of APC in various types of upper gastrointestinal bleeding.
Patients and Methods: The present study was designed as a prospective and observational study. A total of 254 consecutive patients with upper gastrointestinal bleeding (excluding variceal bleeding) were primarily treated using APC. If it was difficult to achieve complete hemostasis with APC alone, injection of a hypertonic saline-epinephrine solution and clipping were carried out. The initial hemostasis rate, rate of recurrent bleeding after APC, permanent hemostasis rate, and mean procedure time were evaluated.
Results: Initial hemostasis with APC alone was achieved in 193 of the 254 patients (75.9 %). With the assistance of other methods as well, initial hemostasis was achieved in 253 patients (99.6 %). Among the 193 patients treated with APC alone, recurrent bleeding was observed in 11 cases (11 of 193, 5.7 %). With one exception, these cases of recurrent bleeding were controlled with APC alone again; permanent hemostasis was thus ultimately achieved with APC alone in 192 of the 254 patients (75.5 %). The mean procedure time was 8 min. No complications (such as perforation) were observed with the APC treatment.
Conclusions: These data indicate that APC is a safe, quick, and effective method of treating various types of nonvariceal upper gastrointestinal bleeding and that it can be a powerful tool for endoscopic hemostasis.


  • 1 Cook D J, Guyatt G H, Salena B J, Laine L A. Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis.  Gastroenterology. 1992;  102 139-148
  • 2 Qvist P, Arnesen K E, Jacobsen C D, Rosseland A R. Endoscopic treatment and restrictive surgical policy in the management of peptic ulcer bleeding: five years’ experience in a central hospital.  Scand J Gastroenterol. 1994;  29 569-576
  • 3 James Y W, Joseph J Y, Lam Y H. et al . Endoscopic retreatment compared with surgery in patients with recurrent bleeding after initial endoscopic control of bleeding ulcers.  N Engl J Med. 1999;  340 751-756
  • 4 Chung S S, Lau J Y, Sung J J. et al . Randomized comparison between adrenaline injection alone and adrenaline injection plus heat probe treatment for actively bleeding ulcers.  Br Med J. 1997;  314 1307-1311
  • 5 Hachisu T. Evaluation of endoscopic hemostasis using an improved clipping apparatus.  Surg Endosc. 1988;  2 13-17
  • 6 Nagayama K, Tazawa J, Sakai Y. et al . Efficacy of endoscopic clipping for bleeding gastroduodenal ulcer: comparison with topical ethanol injection.  Am J Gastroenterol. 1999;  94 2897-2901
  • 7 Goto H, Ohta S, Yamaguchi Y. et al . Prospective evaluation of Hemoclip application with injection of hypertonic saline solution for hemostasis in unstable patients with shock caused by upper GI bleeding.  Gastrointest Endosc. 2002;  56 78-82
  • 8 Protell R L, Rubin C E, Auth D C. et al . The heater probe: a new endoscopic method for stopping massive gastrointestinal bleeding.  Gastroenterology. 1978;  74 257-262
  • 9 Choudari C P, Rajigopal C, Palmer K R. Comparison of endoscopic injection therapy versus the heater probe in major peptic ulcer haemorrhage.  Gut. 1992;  33 1159-1161
  • 10 Lazo M D, Andrade R, Medina M C. et al . Effect of injection sclerosis with alcohol on the rebleeding rate of gastroduodenal peptic ulcers with nonbleeding visible vessels: a prospective controlled trial.  Am J Gastroenterol. 1992;  87 843-846
  • 11 Asaki S. Efficacy of endoscopic pure ethanol injection method for gastroduodenal ulcer bleeding.  World J Surg. 2000;  24 294-298
  • 12 Cipolletta L, Bianco M A, Rotondano G. et al . Prospective comparison of argon plasma coagulator and heater probe in the endoscopic treatment of major peptic ulcer bleeding.  Gastrointest Endosc. 1998;  48 191-195
  • 13 Asakura Y, Imai Y, Arai S. et al . Efficacy of argon plasma coagulation for bleeding gastroduodenal ulcers.  Dig Endosc. 2002;  14 99-102
  • 14 Grund K E, Storek D, Farin G. Endoscopic argon plasma coagulation (APC): first clinical experiences in flexible endoscopy.  Endosc Surg Allied Technol. 1994;  2 42-46
  • 15 Robertson G S, Thomas M, Jamieson J. et al . Palliation of oesophageal carcinoma using the argon beam coagulator.  Br J Surg. 1996;  83 1769-1771

M. Kanai, M. D.

Center for Gastrointestinal Endoscopy · Kyoto Katsura Hospital

17 Yamada Hirao-cho · Nishikyo-ku · Kyoto, 615-8256 · Japan

Fax: + 81-75-381-0090

Email: kanai@kuhp.kyoto-u.ac.jp