Argon plasma coagulation is effective for prevention of recurrent esophageal varices after endoscopic injection sclerotherapy: Single-center case-control study

• Published in: Digestive endoscopy Vol. 28; no. 1; pp. 42 - 49
• Main Authors: Deguchi, Hisanobu, Kato, Jun, Maeda, Yoshimasa, Moribata, Kosaku, Shingaki, Naoki, Niwa, Toru, Inoue, Izumi, Maekita, Takao, Iguchi, Mikitaka, Tamai, Hideyuki, Ichinose, Masao
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01-01-2016
• Subjects: Adult; Aged; Aged, 80 and over; argon plasma coagulation (APC); Argon Plasma Coagulation - methods; case-control study; endoscopic injection sclerotherapy (EIS); Endoscopy, Gastrointestinal - methods; Esophageal and Gastric Varices - complications; Esophageal and Gastric Varices - prevention & control; Female; Gastrointestinal Hemorrhage - epidemiology; Gastrointestinal Hemorrhage - etiology; Gastrointestinal Hemorrhage - prevention & control; Humans; Incidence; Injections; Japan - epidemiology; Male; Middle Aged; Prospective Studies; Recurrence; recurrent esophageal varices; Sclerosing Solutions - administration & dosage; Sclerosing Solutions - adverse effects; Sclerotherapy - adverse effects; Sclerotherapy - methods; telangiectasia; Treatment Outcome; argon plasma coagulation (APC); recurrent esophageal varices; endoscopic injection sclerotherapy (EIS); telangiectasia; case-control study
• ISSN: 0915-5635; 1443-1661
• DOI: 10.1111/den.12538

Background and Aim
Esophageal varices are usually treated with endoscopic injection sclerotherapy (EIS) or endoscopic band ligation (EBL). However, frequent recurrences of varices after those procedures have been problematic. Argon plasma coagulation (APC) after EIS may be effective for preventing varix recurrence and, in recent years, we have routinely carried out APC after EIS. The aim of the present study was to verify the effectiveness of APC for preventing recurrence of varices after EIS.
Methods
A case–control study was carried out using a historical control cohort in a single center. The varix recurrence rate in 62 patients (34 men and 28 women, median age; 69 years) who underwent APC after EIS for hemorrhagic or risky esophageal varices (APC group) was compared with that of control patients who did not undergo APC after EIS (control group). Age‐, sex‐, and liver function‐matched two control subjects were selected for one case subject (control group). Recurrence of varices was defined as rupture of varices or reappearance of risky varices.
Results
The 1‐year and 2‐year recurrence rates of the APC group were 9.7% and 11.3%, respectively. In contrast, the rates of the control group were 29.0% and 34.7%, respectively. Kaplan–Meier curves showed a significantly lower recurrence rate in the APC group (P = 0.013, log–rank test). No APC‐related severe adverse events were observed.
Conclusion
APC after EIS was safe and could significantly prevent recurrence of esophageal varices. Therefore, the addition of APC should be routinely carried out after EIS.