Efficacy of argon plasma coagulation in treatment of endobronchial lesions

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Efficacy of argon plasma coagulation in treatment
of endobronchial lesions

• Tuncay GÖKSEL
• Mustafa H. ÖZHAN
• Tolga ÖZ
• Öznur AYDOGAN
• Berna YILDIRIM
• Alev ATASEVER
• Gürsel ÇOK
• Ege University Medical School
• Dept.of Pulmonary Medicine

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Argon plasma coagulation (APC)

• APC is a non-contact electrocoagulator
• Plasma is an electrically conducting medium
  produced when the atoms in a gas become ionized

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A Desiccation B Coagulation C Devitalization

• Advantages of non-contact electrocoagulation
• Minimal manipulation
• Lower risk for mechanical trauma to target tissue
  and bleeding
• Rapid coagulation in larger area

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Materials and Methods

• A research project of Ege University
• Early results of a prospective and one arm study
• Patients with endobronchial obstruction or
  hemoptysis were eligible for this study
• Fiberoptic bronchoscope (via oral)
• Morphine (Midazolam Propofol)
• Lidocain
• Cardiac monitoring
• Nasal oxygen

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Results

• April 2005 January 2006 early results
• 21 patients
• Mean age 59.4212.31
• Male 18 Female 3
• Rigid fiberoptic bronchoscopy in 2 patients
• Bronchoscopic interventions were immediately
  terminated in 2 patients
• 1 case pulmonary edema
• 1 case severe cardiac arrhythmia

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• Diagnosis
• 17 patients lung cancer
• 16 NSCLC
• 1 Combined SCLC
• 4 patients Benign reasons (granulotion tissue
  due to stent

• Indications for intervention
• 18 patients obstruction
• 2 patients hemoptysis
• 1 patient obstructive pneumonia

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• Locations of airway lesions
• Trachea 8 patients
• Main bronchi 9 patients
• Bronchus intermedius 1 patient
• Right upper lobe 2
• Right middle lobe 1

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Other endobronchial therapies

• Cryotherapy 7 patients
• Brachytherapy 4 patients
• Nitinol stent 2 patients

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Response 1

• Endobronchial obstruction
• Response 15/17 cases (88.2)
• Mean obstruction
• Pre intervention ? 85.55 14.23
• Post intervention ? 43.88 30.51
• -------------------------------------------------
• Tumor length gt 4 cm in 2 two patients
• Distal airway was not opened

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Response 2

• Response for hemoptysis
• 2/2 cases (100)
• Improvement of symptoms
• 17/19 cases (89.5)

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• Side effects
• Hemoptysis
• 50 100 cc 4 cases
• gt 100 cc 1 case
• Hypoxemia 3 cases
• Bronchial spasm 1 case
• Hypotension 3 cases
• Hypertension 5 cases
• Tachycardia 5 cases
• Bradycardia 1 case
• --------------------------------------------------
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• Bronchoscopic interventions were immediately
  terminated in 2 patients
• 1 case pulmonary edema
• 1 case severe cardiac arrhythmia

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Case 1
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Case 2a
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Case 2b
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Case 3
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Conclusion

• APC is a safe and effective therapy alternative
  in palliation of endobronchial lesions, which can
  be combined with other palliative technique