• Vol. 34 No. 9, 569–570
  • 15 October 2005

Gastric Pneumatosis after Endoscopic Argon Plasma Coagulation



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Introduction: Endoscopic argon plasma coagulation (APC) is gaining widespread usage but its risk is underreported. Clinical Picture: A 74-year-old man who received radical radiotherapy for gastric carcinoma 6 months ago was admitted for anaemia and maelena. Gastroscopy revealed haemorrhagic radiation gastritis. Endoscopic APC was performed but terminated when he complained of severe epigastric pain. Computed tomography scan showed gastric pneumatosis. Treatment: His pain subsided with a period of overnight rest and observation. Outcome: He continued to have 3 sessions of endoscopic APC at monthly intervals and at 10 months posttreatment, his haemoglobin remained stable at 11.1 g/dL. Conclusions: This case report highlights a complication of gastric pneumatosis and discusses the safe usage of this modality of endoscopic haemostasis. This is to increase cognisance of this potentially fatal complication among endoscopists.

Argon plasma coagulation (APC) is a major haemostatic modality for large surface bleeding areas.1 It effects thermal coagulation with limited and controlled tissue depth by using high-frequency monopolar electrosurgical current via an ionised argon gas stream. When used endoscopically, a flexible probe passed through the accessory channel provides non-contact end-on and tangential flow effect. In spite of its expanding field of therapy, there has been a paucity of reports on its complications and safety tips on its usage.

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