Electrocautery and Argon Plasma Coagulation

Electrocautery and Argon Plasma Coagulation

[Argon plasma coagulation in bronchology: a new method–alternative or complementary?]

https://www.ncbi.nlm.nih.gov/pubmed/11132548

Landmark Article 

Reference: Reichle G, Freitag L, Kullmann HJ, Prenzel R, Macha HN, Farin G. [Argon plasma coagulation in bronchology: a new method–alternative or complementary?]. Pneumologie. 2000;54(11):508-16.

Background: Largest prospective study (384 patients) using Argon Plasma Coagulation (APC) to determine the effectiveness in treatment of malignant airway endoluminal obstruction. Only study looking at various aspects and feasibility of APC for endoluminal therapy in a single study.

PICO:

Populations:

  • Patients with malignant tumor obstruction of the airway

Intervention:

  • Use of APC for re-establishing endoluminal patency, treating hemoptysis and recanalizing occluded stents.

Comparison:

  • None

Outcome:

  • 67% cases had good establishment of airway patency. Very good hemostatic effect was attained in acute hemoptysis from tumor bleeds (118/119 cases). In recanalization of stents, it was a safe modality without any complications or fire with metal or plastic stents. It achieved stent recanalization in 36/39 patients (73%) very effectively. Its use in benign tumors and laryngotracheal papillomatosis also resulted in prolonged disease-free periods and reduced recurrence.

Take Home: Bronchoscopic treatment with APC is a cost-effective modality for various uses including treatment of endoluminal disease. It has comparable effects with the Nd-YAG laser with good hemostasis and coagulation properties.


 The use of electrocautery as the primary ablation modality for malignant and benign airway obstruction

https://www.ncbi.nlm.nih.gov/pubmed/21792075

Clinical Trial 

Reference: Wahidi MM, Unroe MA, Adlakha N, Beyea M, Shofer SL. The use of electrocautery as the primary ablation modality for malignant and benign airway obstruction. J Thorac Oncol. 2011;6(9):1516-20.

Background: Largest retrospective single center study (94 patients, 117 procedures) evaluating the effectiveness of EC as the primary modality for resolution of malignant and benign airway obstructions.

PICO:

  • Populations:Patients with malignant and benign airway obstructions

Intervention:

  • Use of EC for reestablishing endoluminal patency from tumor obstruction

Comparison:

  • None

Outcome:

  • Endoscopic improvement was seen in 94% of cases. 74% of patients reported symptomatic improvement. Radiographic studies demonstrated luminal improvement in 78% of patients on chest CT. The rate of major complications was 0.8%, whereas minor complications occurred in 6.8% of cases.

Take Home: Endobronchial EC is an effective ablative modality for treatment of malignant and benign airway obstruction and is comparable to laser, with the advantage of being readily available and less expensive.


 The heat is on: impact of endobronchial electrosurgery on the need for Nd-YAG laser photoresection

https://www.ncbi.nlm.nih.gov/pubmed/10936149

Landmark Article 

Reference: Coulter TD, Mehta AC. The heat is on: impact of endobronchial electrosurgery on the need for Nd-YAG laser photoresection. Chest. 2000;118(2):516-21.

Background: Small, prospective, observational case series in an outpatient bronchoscopy setting, evaluating use of EC surgery and flexible bronchoscopy instead of Nd-YAG laser in the operating room for treatment of endobronchial lesions.

PICO:

Populations:

  • Patients needing endobronchial intervention with laser

Intervention:

  • Use of EC surgery for endobronchial lesions instead of using laser in those cases

Comparison:

  • None

Outcome:

  • 47 procedures performed, 42 (89%) were successful in alleviating the obstruction, thus eliminating the need for laser resection. No major complications were encountered.

Take Home: Small series with some selection bias, but reiterates the possibility of using low cost EC over laser as the first tool for therapeutic treatment of endobronchial disease, especially with flexible bronchoscopy in an outpatient setting.