Bronchoscopic argon plasma coagulation in the management of airway disease in adults
- Francis D Sheski, MD
Francis D Sheski, MD
- Associate Professor of Clinical Medicine
- Indiana University School of Medicine
Argon plasma coagulation (APC) is an electrosurgical, noncontact thermal ablation technique that uses argon gas to generate heat, which, in turn, can be used to resect tissue and/or to achieve hemostasis. While its use was originally focused on achieving surgical hemostasis and debulking gastrointestinal tumors, APC has since been used during bronchoscopy for similar purposes.
In this topic review, the indications, contraindications, procedural technique, and complications of bronchoscopic APC for the management of airways disease are presented. Other bronchoscopic techniques used to manage airway obstruction and the use of APC in the management of gastrointestinal bleeding are described separately. (See "Clinical presentation, diagnostic evaluation, and management of central airway obstruction in adults" and "Endobronchial electrocautery" and "Endobronchial photodynamic therapy in the management of airway disease in adults" and "Airway stents" and "Flexible bronchoscopy balloon dilation" and "Endobronchial brachytherapy" and "Bronchoscopic laser in the management of airway disease in adults" and "Bronchoscopic cryotechniques in adults".)
PRINCIPLES OF ARGON PLASMA COAGULATION
Contrary to a common misconception, argon plasma coagulation (APC) is not a laser. Argon gas (also known as argon plasma) is expelled from a probe and then a high-voltage electric current is passed along the probe. When the electric current contacts the argon gas, it becomes ionized and conducts a monopolar electric current that "grounds" itself to the nearest target lesion (picture 1) . Thermal energy is delivered with a depth of penetration of roughly 2 to 3 mm. The heat produced denatures protein and evaporates intra- and extracellular water with the net effect of tissue destruction and coagulation.
Due to these features, APC is a useful modality for the treatment of superficial/flat lesions, as well as those that are highly vascular or bleeding. Although the shallow depth of penetration compared with laser means that it is not as efficient at debulking tissue, it can still be used successfully for this purpose. In contrast with laser, the plasma coagulates both linearly and tangentially; thus, when ionized gas travels linearly, it coagulates the lesion in direct view of the bronchoscope, but, once it meets resistance, it travels laterally such that it can be used to treat lesions around folds or bends that are not clearly in view. (See "Bronchoscopic laser in the management of airway disease in adults", section on 'Principles of laser resection'.)
Argon gas is nonflammable and inexpensive to refill, making it one of the cheaper bronchoscopic ablative techniques available to interventional bronchoscopists.
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- PRINCIPLES OF ARGON PLASMA COAGULATION
- INDICATIONS AND EFFICACY
- Central airway obstruction
- - Malignant
- Patient or tumor characteristics
- Comparison with other techniques
- - Benign
- Controlling airway bleeding
- Early airway lung cancer not amenable to surgery
- Patients with extrinsic compression
- Patients on high-flow oxygen
- EQUIPMENT AND PROCEDURE
- Equipment settings
- POSTOPERATIVE CARE
- SUMMARY AND RECOMMENDATIONS