Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Bronchoscopic argon plasma coagulation in the management of airway disease in adults

Francis D Sheski, MD
Section Editor
Praveen N Mathur, MB, BS
Deputy Editor
Geraldine Finlay, MD


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".)


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) [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.


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Jul 12, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Platt RC. Argon plasma electrosurgical coagulation. Biomed Sci Instrum 1997; 34:332.
  2. Reichle G, Freitag L, Kullmann HJ, et al. [Argon plasma coagulation in bronchology: a new method--alternative or complementary?]. Pneumologie 2000; 54:508.
  3. Crosta C, Spaggiari L, De Stefano A, et al. Endoscopic argon plasma coagulation for palliative treatment of malignant airway obstructions: early results in 47 cases. Lung Cancer 2001; 33:75.
  4. Morice RC, Ece T, Ece F, Keus L. Endobronchial argon plasma coagulation for treatment of hemoptysis and neoplastic airway obstruction. Chest 2001; 119:781.
  5. Vonk-Noordegraaf A, Postmus PE, Sutedja TG. Bronchoscopic treatment of patients with intraluminal microinvasive radiographically occult lung cancer not eligible for surgical resection: a follow-up study. Lung Cancer 2003; 39:49.
  6. Jabbardarjani H, Masjedi M, Herth F. Successful treatment of endobronchial carcinoid using argon plasma coagulation. J Bronchology Interv Pulmonol 2009; 16:196.
  7. Cetinkaya E, Aras G, Sökücü SN, et al. Treatment of endoluminal typical carcinoid tumor with bronchoscopic techniques. Tuberk Toraks 2009; 57:427.
  8. Ernst A, Simoff M, Ost D, et al. Prospective risk-adjusted morbidity and mortality outcome analysis after therapeutic bronchoscopic procedures: results of a multi-institutional outcomes database. Chest 2008; 134:514.
  9. Miller SM, Bellinger CR, Chatterjee A. Argon plasma coagulation and electrosurgery for benign endobronchial tumors. J Bronchology Interv Pulmonol 2013; 20:38.
  10. Ucer M, Ordu C, Pilanc KN, Dalar L. Tracheomediastinal fistula in a patient with lung adenocarcinoma and its treatment with argon plasma coagulation: a case report. Medicine (Baltimore) 2014; 93:e156.
  11. Aynaci E, Kocatürk CI, Yildiz P, Bedirhan MA. Argon plasma coagulation as an alternative treatment for bronchopleural fistulas developed after sleeve pneumonectomy. Interact Cardiovasc Thorac Surg 2012; 14:912.
  12. Sharifi A, Nazemieh M, Moghadaszadeh M. Supraglottic Hemangioma as a Rare Cause of Recurrent Hemoptysis: A New Treatment Modality with Argon Plasma Coagulation (APC). Tanaffos 2014; 13:50.
  13. Dalar L, Sökücü SN, Özdemir C, et al. Endobronchial argon plasma coagulation for treatment of Dieulafoy disease. Respir Care 2015; 60:e11.
  14. Goudie E, Kazakov J, Poirier C, Liberman M. Endoscopic lung abscess drainage with argon plasma coagulation. J Thorac Cardiovasc Surg 2013; 146:e35.
  15. Bugalho A, Oliveira A, Semedo J, et al. Argon-plasma treatment in benign metastasizing leiomyoma of the lung: a case report. Rev Port Pneumol 2010; 16:921.
  16. Keller CA, Hinerman R, Singh A, Alvarez F. The use of endoscopic argon plasma coagulation in airway complications after solid organ transplantation. Chest 2001; 119:1968.
  17. Colt, HG. Bronchoscopic resection of Wallstent-associated granulation tissue using argon plasma coagulation. J Bronchol 1998; 5:209.
  18. Schuurman B, Postmus PE, van Mourik JC, et al. Combined use of autofluorescence bronchoscopy and argon plasma coagulation enables less extensive resection of radiographically occult lung cancer. Respiration 2004; 71:410.
  19. Petersen BT, Hussain N, Marine JE, et al. Endoscopy in patients with implanted electronic devices. Gastrointest Endosc 2007; 65:561.
  20. Reddy C, Majid A, Michaud G, et al. Gas embolism following bronchoscopic argon plasma coagulation: a case series. Chest 2008; 134:1066.
  21. Shaw Y, Yoneda KY, Chan AL. Cerebral gas embolism from bronchoscopic argon plasma coagulation: a case report. Respiration 2012; 83:267.
  22. Matveychuk A, Guber A, Talker O, Shitrit D. Incidence of bacteremia following bronchoscopy with argon plasma coagulation: a prospective study. Lung 2014; 192:615.
  23. Colt HG, Crawford SW. In vitro study of the safety limits of bronchoscopic argon plasma coagulation in the presence of airway stents. Respirology 2006; 11:643.