Argon plasma coagulation (APC) is a thermal coagulation technique that uses ionized
argon to transmit high-frequency electrical current, contact free, to tissue. APC has been used in surgery for more than 20 years, particularly for the hemostasis of superficial
bleeding. Although APC has become well established in gastrointestinal endoscopy since its introduction in 1991, very few reports of its use in bronchoscopy exist to date. From June 1994 to June 1998, 364 patients (80 women, 284 men), 88% with a confirmed malignant
tumor, were treated prospectively in a total of 482 sessions. The single most common indication was recanalization of malignant airway
stenoses (186 patients). The defined
therapy objective was achieved with good results in 67% of patients. More than 90% of interventions were performed with rigid bronchoscopy. Despite less penetration compared with
Nd:YAG laser, extensive bronchial
tumors were treatable, in which coagulated
tumor fractions were removed either with
forceps or
bronchoscope tip. The second indication was
bleeding in the central airways (119 patients). Acute hemostasis was achieved in 118 patients, 20% in whom the flexible technique under
local anesthesia was used. In 34 patients, APC was successfully used to recanalize occluded
stents. Rare indications included benign endobronchial
tumor,
fistula conditioning before
fibrin adhesion, and the treatment of
scar tissue
stenosis. Summarizing all complications, a rate of 3.7% "per treatment" was recorded. Two patients died within 24 hours; their deaths were not directly related to APC. APC is an effective and safe technique for the treatment of bronchologic
tumor ablation and hemostasis and can be used with local anaesthetic with flexible bronchoscopy or rigid bronchoscopy with
general anesthesia. Compared with
Nd:YAG laser, APC is an economic alternative technique offering more effective hemostasis. Furthermore, APC is of particular value as a compliment to well-known techniques, increasing the options in interventional bronchoscopy.