Introduccin

Indicaciones
Resultados
Seguridad
Conclusiones
INTRODUCCION
La coagulacin con argn plasma es un mtodo de no
contacto que se aplica utilizando corriente monopolar
de alta frecuencia a travs de la ionizacin del gas
argn
Introducido a la endoscopia en 1991
Multiples aplicaciones
INDICACIONES
Ablativas
Esfago de Barrett
Lesiones planas
Complemento a la reseccin
Tratamiento paliativo de
neoplasias estenosantes
Otras
Diverticulo de Zenker
Recanalizacin de prtesis
Corte de prtesis
Hemostticas
Lesiones vasculares
Ectasias
Proctopatia postradioterapia
Ulceras Ppticas
Erradicacin de vrices
esofgicas
INDICACIONES
Ablativas
Esfago de Barrett
Lesiones planas
Complemento a la reseccin
Tratamiento paliativo de
neoplasias estenosantes
Otras
Diverticulo de Zenker
Recanalizacin de prtesis
Corte de prtesis
Hemostticas
Lesiones vasculares
Ectasias
Proctopatia
postradioterapia
Ulceras Ppticas
Erradicacin de vrices
esofgicas
Seguridad
Procedimiento seguro
Las complicaciones reportadas van de 0 % a 24 %
La mayora son menores
Distensin gastrointestinal,
Pneumatosis intestinal
Pneumoperitoneo
Pneumomediastino
Enfisema subcutneo
Dolor
Hemorragia
Sndrome de quemadura transmural
Perforacin
ASGE. Tech. Review. Gastrointest Endosc.2002:55:807-11
ASGE.Tech Review. Gastrointest. Endosc.2004:;59:81-88

FICE
NBI
Vargo J. Clinical applications of the argon plasma
coagulator. Gastrointest Endosc 2004;59:81-87
Diez series: 304 pacientes
Complicaciones menores
Dolor torcico y odinofagia
El porcentaje global de regresin fue del 82.6%
Focos sub epiteliales de Barrett hasta en el 50%
En displasia y cncer in situ resultados controversiales
No progresin hasta la progresin de displasia a cncer
En la actualidad es un mtodo poco usado
Mejores mtodos endoscpicos de tratamiento
OBJETIVO. Evaluar elimpacto del AP en el manejo de lesiones vasculares G-I
en las transfusiones, nivel de hemoglobina y la seguridad del
procedimiento
METODOS. Retrospectivo, que incluyo a los enfermos con Angioectasias
sangrantes, seguimiento va telefonica o a travs del expediente clnico
RESULTADOS.Cien pacientes, 46 hombres y edad promedio de 74 aos,
seguimiento de 16 meses. Las lesiones tratadas fueron malformaciones
arteriovenosas (74) y GAVE (26). Los requerimientos transfusionales se
abolieron en el 77% y en el resto disminuyeron y la hemoglobina mejor
en todos.
CONCLUSIONES: El AP es efectivo y seguro en esta patologa
Kwan. Et al Argon Plasma Coagulation in the Management of Symptomatic
Gastrointestinal Vascular Lesions: Experience in 100 Consecutive Patients
with Long-Term Follow-Up. Am J Gastroenterol 2006;101:5863

EXPERIENCIA DE DOS AOS EN EL TRATAMIENTO DE LAS
ECTASIAS VASCULARES CON ARGON PLASMA
OBJETIVO.- Evaluar la efectividad del tratamiento con argn plasma (APC) en las
lesiones vasculares del tubo digestivo proximal.
METODO y METODO.- Se evaluaron de forma retrospectiva a los enfermos con
diagnstico de lesin vascular gstrica de junio del 2009 a junio del 2011, que fueron
tratados por APC.
ANALISIS.- Se defini xito total cuando hubo correccin de la anemia y no requiri
transfusin despus del tratamiento con argn plasma, xito parcial cuando el nmero de
transfusiones requeridas era menor o igual al 50% de lo que habitualmente requera el
paciente y no xito cuando no se encontr una disminucin mayor al 50 % de los
requerimientos transfusionales o cuando el paciente continuaba presentando las lesiones
vasculares en la endoscopia de control.
RESULTADOS.- Se aplicaron 88 tratamientos con APC a 17 pacientes con lesiones
vasculares gstricas. Se logr xito total en 13 pacientes, 3 pacientes lograron xito parcial
y en 1 paciente no se logr xito.
CONCLUSIONES.- El tratamiento con APC demostr ser efectivo en nuestro estudio, se
debe realizar un estudio ms prolongado para tener conclusiones vlidas a cerca de la
efectividad de este manejo.

OBJETIVO. Evaluar la eficacia del AP en el manejo de los diferentes tipos de
angiodispolasias con o sin hemorragia activa al momento de la endoscopia
METODOS. 28 pacientes, Diez con angiodisplasia focal, 11 gastropatia
hipertensiva portal y 8 GAVE, se analizaron los factores demogrficos,
formula roja y requerimientos trasfusionales de cada uno de los subtipos
de ectasias vasculares en un seguimiento de 13.6 meses
RESULTADOS. El tratamiento fue exitosos en la mayoria de los enfermos sin
diferencias significativas entre los tres grupos y no se presentaron
complicaciones
CONCLUSIONES. El AP es til y seguro en las diferentes presentaciones de
ectasias vasculares gstricas
Bordas. APC in the treatment of the different Types of Gastric
Angiodysplasia a series of consecutive Patients diagnosed by
acute GI Bleeding Gastrointest Endosc 2006;63:AB183
La mayora de los estudios son retrospectivos
No son controlados (serie de casos)
Los resultados son buenos
Prcticamente sin complicaciones
Necesidad de mejores estudios y seguimientos a ms
largo plazo.
Esto mismo ocurre en las lesiones del Intestino
delgado
El tratamiento con AP en proctitis postradioterapia es
efectivo
Los resultados son buenos
Serie de casos
Las complicaciones aumentan en frecuencia,
Hasta el 19%
Tenesmo, distensin, anismo
INDICACION AP NIVEL DE
EVIDENCIA
PROCTITIS POS
RT
40-60 w
0.6 A 3.0 L/min
3
ECTASIAS
GASTRICAS
40-100 w
2.0 L/min
3
ANGIOECTASIAS 40-60 w 3
ESFAGO DE
BARRETT
30-90 w
0.1 A 2.0 L/min
3, 2







El AP es una herramienta til y segura en endoscopia
gastrointestinal
El nivel de evidencia sobre la utilidad en la mayora de las
indicaciones es de 3
Es necesario realizar estudios prospectivos, comparativos y a
largo plazo para evaluar la utilidad real de este tipo de
tratamiento
Los resultados son mejores en ectasias vasculares aisladas que en
otras indicaciones
S1528
Therapeutic Double Balloon Enteroscopy Reduces Transfusion
Requirements in the Management of Occult or Obscure
Gastrointestinal Bleeding
Mark E. Benson, Courtney Barancin, Roberto M. Gamarra, Nalini
M. Guda, Sigurdur Einarsson, Anurag Soni, Deepak V. Gopal
Introduction: Patients with occult or obscure gastrointestinal (GI) bleeding can be
challenging to manage. Double Balloon Enteroscopy (DBE) is a novel procedure
enabling therapeutic interventions within most of the small bowel. Further research
regarding the clinical impact of these interventions is needed. Aim: To evaluate the
impact of therapeutic DBE on packed red blood cell transfusion requirements in
patients with occult or obscure GI bleeding. Methods: This is a retrospective review of
patients who underwent DBE at two tertiary care centers from 5/07 to 10/08 with
a focus on patients who had therapeutic endoscopic interventions for occult or
obscure GI bleeding. A Students T-test and Chi square analysis were used for
comparison of samples with significance considered if the P value was less than 0.05.
Results: There were 77 patients, mean age 64 years (14-89), who underwent DBE in
the 18 month period. Of the 77 patients, 70 had occult or obscure GI bleeding. Fortyseven
(67%) of the 70 patients had endoscopic findings potentially accounting for the
blood loss. These small bowel lesions varied in location from the mid-Jejunum to
proximal-mid Ileum and were out of reach via standard small bowel enteroscopy or
colonoscopy with Ileoscopy. Forty patients had arterio-venous malformations(AVMs),
4 patients had small bowel ulcerations, 1 patient had celiac disease, 1 patient had
a bleeding small bowel (mid-Ileum)polyp and 1 patient had bleeding jejunal
diverticula. Forty-two (60%) of the 70 patients had therapeutic DBE interventions
including argon plasma coagulation (NZ41), hemoclip placement (NZ3) and snare
polypectomy (NZ1). Among the patients with therapeutic interventions, there was
a statistically significant per patient decrease in the amount of blood units transfused
during the preceding 6 months, [mean 1.8 units (rangeZ0-20)] compared to the 6
months after the DBE exam, [mean 0.3 units (rangeZ0-5)]; (PZ0.04). There were 3
patients who had post procedure GI bleeding within 30 days after therapeutic DBE; all
were managed conservatively. This was not significantly higher compared to the
group of patients who did not have a therapeutic intervention (PZ 0.17).
Conclusions: 1) Therapeutic DBE results in a long-term and clinically significant
beneficial outcomes among patients with occult or obscure GI bleeding as noted by
a decrease need for red blood cell transfusion requirements. 2) AVMs are the most
commonly treated lesion in patients with occult or obscure GI bleeding. 3)
Therapeutic DBE is a safe procedure. 4) Gastroenterologists who performDBE need
to be aware of the its potential therapeutic benefits.
Gastrointestinal Endoscopy Vol. 69, Issue
5, Page AB194
W1436
Diagnostic Yield and Therapeutic Utility of Double-Balloon
Enteroscopy (DBE) in Patients with Obscure Gastrointestinal
Bleeding (OGIB): A Systematic Review
Shabana F. Pasha, Jonathan A. Leighton, Ananya Das,
M Edwyn Harrison, G Anton Decker, David E. Fleischer, Virender
K. Sharma
Background: DBE is a relatively new endoscopic modality that allows for a more
extensive evaluation of the small bowel and treatment of lesions previously
inaccessible by conventional enteroscopy. Complete enteroscopy is possible,
usually with a combination of an antegrade and retrograde approach. Aim: A
systematic review of the literature on DBE was undertaken to determine its
diagnostic and therapeutic yield in patients with OGIB. Methods: A recursive
literature search of studies evaluating the role of DBE in the diagnosis and
treatment of patients with OGIB was performed. Data on DBE findings, treatment
and patient outcomes were extracted, pooled and analyzed. Results: Thirteen
studies evaluated the role of DBE in patients with OGIB (8 manuscripts and 5
abstracts). The studies included 906 patients with 28.5% males (140/490); mean age
56.5 years (range 8-94 years). The number of DBEs performed per patient was 1.3
(range 1-2). DBE detected a potential bleeding source in 66% of patients (596/906;
95% CI 63-69). The findings included arteriovenous malformations in 25.6%
patients (206/804; 95% CI 22.6-28.7); inflammatory lesions (ulcers, erosions or
strictures) in 16.1% (130/804; 95% CI 13.6-18.9) and small bowel neoplasms
(polyps/tumors) in 13.9% (112/804; 95% CI 11.6-16.5). Subsequent management
(medical, surgical or endoscopic) was influenced by DBE findings in 44% patients
(355/818; 95% CI 40-47). Endoscopic treatment was performed in 26.6% patients
(189/709; 95% CI 23.4-30), and included argon plasma coagulation (62%; 117/189),
electrocoagulation (21.6%; 41/189) and polypectomy (3%; 6/189). Eight-four
percent of patients (169/200; 95% CI 78.7-89.2) remained transfusion free over
a mean follow-up period of 229 days (range 30-480). Conclusion: DBE is an exciting
new technology that plays an important role in the diagnosis and treatment of
patients with OGIB. Its diagnostic yield is comparable to capsule endoscopy, as
reported from prior studies, and superior to other small bowel imaging modalities.
DBE results may lead to a new diagnosis, change in management or improve
outcomes in a majority of patients with OGIB.
Gastrointestinal Endoscopy Vol. 65, Issue
5, Page AB366