Pain sensation and neuromuscular stimulation during Argon-Plasma-Coagulation (APC) in gastrointestinal endoscopy

Aims: APC is a thermal coagulation technology that uses ionized argon to transmit high-frequency electrical current, contact free, to tissue. Prospective data on complications with the new APC-2 (VIO-) system are missing.

Methods: Prospective trial of 152 patients (pts.) which were treated with 3 modes of APC-2 for various indications of gastrointestinal diseases. The aim of the study was to assess complications, with a focus on pain sensation and neuromuscular stimulation (NMS). Patients reported pain and NMS during APC on a scale from 0 to 10 and were interviewed for symptoms like cribbling, paresthesia, muscle pain and cramping or twitching. NMS was graded by the endoscopists on a questionaire as well.

Results: Overall, 85 males and 67 females with an median age of 66 years entered the study. All APC therapies were successfully finished. We noticed 2 periinterventional perforations. 26 of 152 (17%) cases reported pain sensation during or after APC. Median pain sensation reported by the patients on the standardized scale was 3.7. NMS was seen in 14 of 152 (9.2%) patients. Significantly more NMS events were seen with PULSED APC than with FORCED or PRECISE APC. Additional risk factors for NMS were gender ♀ and type of sedation (combination of midazolam+pethidine). Patients with intracardial defibrillators or cardiac pacemakers did not show any complication.

Conclusions: APC could be associated with minor complications like pain sensation and neuromuscular stimulation. These complications were seen rarely but more often with PULSED APC than with FORCED or PRECISE APC. Physicians should be aware of these complications.