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Acta Gastro-Enterologica Belgica, Vol. LXX, October-December 2007 352
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ORIGINAL ARTICLE
Abstract
Background :The aim of this study was to evaluate the effect of 2 nd generation argon plasma coagulation (VIO APC) with respect to the tissue destruction capacity, and to compare it with standardAPC and Nd:YAG laser.
Methods :2
nd generation APC (VIO APC2, Erbe, Germany), standard APC (APC 300/Erbotom ICC 200, Erbe) and Nd:YAG laser (KTP/YAG XP 800 ; Laserscope, San Jose, California) were applied in 35 porcine livers. Using APC, power settings (30-120 W), application time (2 and 5 sec) and gas flow (1 and 2 l/min)
were varied. Using Nd:YAG laser, 30-60 W were applied (flow 2 l/min). Diameter and depth of tissue coagulation were evaluated. Results :Using VIO APC, maximum coagulation depth was6mm (maximum diameter 15 mm). In comparison to standard
APC, the coagulation effect was significantly higher (p < 0.001). There was no significant difference in the mean depth achieved by VIO APC and Nd:YAG laser using 30- 60 W and an application time of 2 sec (p < 0.05). Using maximum energy available for the2 systems, maximum depth achieved by VIO APC (6 mm) was
higher than the one caused by Nd:YAG laser (4 mm). Conclusions :VIO APC was more effective than standard APC. Using medium power and a limited application time, it was as effective as Nd:YAG laser. The high effectiveness of VIO APC should be a topic of clinical education. (Acta gastroenterol. belg.,2007, 70,352-356).
Key words: VIO APC, argon plasma coagulation, Nd:YAG laser, porcine liver model.Introduction Argon plasma coagulation (APC) is a method of con- tact-free electrocoagulation in which energy is transmit- ted to the tissue through ionized argon gas. Initially developed for the surgical arena, this device has seen an ever-expanding role in therapeutic endoscopy (1-5).Coagulation depth achieved by APC is described to
be mainly a function of the power setting, the duration of the application, and the distance from the target tis- sue (6). Generally, the zone of coagulation is 1-3 mm. The physical properties of the incident tissue also may play a role in determining the depth of tissue injury. Norton et al.(7) used a porcine model to compare the incidence of deep tissue injury, respectively the damage of the deep muscle layer for a variety of endoscopically directed thermal devices. The compact, mobile and easy to handle device, and its relatively low cost favour the choice of APC over comparative treatment modalities, such as Nd :YAG laser, for various forms of gastrointestinal pathology. However, in comparison to the Nd :YAG laser, standardAPC appears to be less effective in palliative tumourreduction, which resulted in a high re-treatment rate ofup to 21 treatment sessions in stenosing ooesophagealcancer (8). On the other hand, the high efficacy of APCin the treatment of superficial lesions such as vascularlesions has been shown (8-17). Now, an APC system ofthe second generation (VIO APC) promises to overcomethe drawbacks of previously offered APC devices.
In contrast to standard APC and Nd:YAG laser, the
thermic effects of VIO APC have not been investigated yet. The aim of this study was to evaluate for the first time the tissue effect of this second generation APC sys- tem, and to compare it with a standard APC system and Nd:YAG laser in a parallel-group trial.Materials and methodsThirty-five porcine livers were obtained from the
slaughter house and were kept in a sealed polythene bag until testing. All specimens were tested within 6 hours of acquiring.An APC system of the second generation (VIO 300 D
with APC 2, Erbe, Tuebingen, Germany), a standardAPC device (APC 300/Erbotom ICC 200, Erbe,
Tuebingen, Germany), and a Nd:YAG laser system
(KTP/YAG XP 800 ; Laserscope, San Jose, California) were used for the study. Power settings of 30, 40, 50 and 60 W were used dur- ing the application of the Nd:YAG laser. 70, 80 and99 W (maximum energy level available) were used addi-
tionally during the application of standard APC (APC300/ICC 200), and 120 W (maximum energy level avail-
able) additionally during the application of VIO APC (VIO 300 D with APC 2). The argon gas flow was varied (1 and 2 l/min). The power setting from 30 to 40 W was defined as the lowenergy level, and the power setting from 50 to 70 W wasThe tissue effect of second generation argon plasma coagulation (VIO APC) in
comparison to standard APC and Nd:YAG laser in vitro Hendrik Manner, Andrea May, Michael Faerber, Oliver Pech, Nicola Plum, Christian Ell Department of Internal Medicine II, HSK Wiesbaden, Wiesbaden, Germany. Correspondence to : Hendrik Manner, M.D., Klinik Innere Medizin II, HSK Wiesbaden, Ludwig-Erhard-Strasse 100, 65199 Wiesbaden, Germany.