Destroy the bleeding vessels and spare the ischemic mucosa

I agree with the statement of H. J. N. Andreyev regarding the use in chronic radiation proctitis of argon plasma coagulation (APC) [1]. Chronic radiation proctitis is basically an ischemic disease where the mucosa is affected. Therefore, any further aggressive action against the overlying epithelium is to be avoided whenever possible. Argon coagulation destroys bleeding vessels [2] but also mucosa and submucosa, and therefore predisposes to later ulcerations which heal slowly, if ever.

This is the reason I have proposed [3] an attempt at an electrocoagulation method for relatively selective coagulation of the bleeding vessels, with minimal damage to the mucosa. Low-intensity long-duration electrocoagulation in fact leads to deeper coagulation, with a relatively selective concentration of the current in the blood vessels as they have lower impedance. Thus, the destruction of the dilated vessels is optimal with minimal coagulation of the overlying mucosa.

This mechanism is even more effective when the current flows through a liquid meniscus between the electrode and the mucosa. This meniscus is formed by superficial tension when the electrode is slowly elevated from the surface, as I have described previously using a closed hot biopsy forceps [3]. The density of the current in the mucosa is even lower if a large 6-mm ball is used instead of forceps [4].

The telangiectatic region is scanned slowly, avoiding any blanching. If bleeding fails to disappear within a week, a further application is performed using a slower scanning speed.

In my experience, this type of treatment is effective for bleeding and does not elicit or worsen possible ulcerations.

Competing interests: None

References

• 1 Andreyev H JN. Argon plasma coagulation in chronic radiation proctitis: Postgate et al.  Endoscopy. 2007;  39 751
• 2 Rolachon A, Papillon E, Fournet J. Is argon plasma coagulation an efficient treatment for digestive system vascular malformation and radiation proctitis?.  Gastroenterol Clin Biol.. 2000;  24 1205-1210
• 3 Maroy B. Traitement endoscopique d’une rectite radique hémorragique et ulcérée rebelle par une nouvelle technique d’électrocoagulation.  Gastroenterol Clin Biol. 1998;  22 556-557
• 4 Maroy B, Lebailly J. Endoscopic electrocoagulation of the digestive tract using a large diameter ball screwed on the flexible device before insertion of the scope [letter].  Endoscopy. 2000;  32 S71