CHEST
Volume 119, Issue 3, March 2001, Pages 781-787
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Clinical Investigations
Endobronchial Argon Plasma Coagulation for Treatment of Hemoptysis and Neoplastic Airway Obstruction

https://doi.org/10.1378/chest.119.3.781Get rights and content

Study objectives:

To evaluate the usefulness of endobronchial argon plasma coagulation (APC) for the treatment of hemoptysis and neoplastic airway obstruction.

Design:

Retrospective study.

Settings:

Bronchoscopy unit of auniversity hospital.

Patients:

A total of 60 patientswith bronchogenic carcinoma (n = 43), metastatic tumors affecting thebronchi (n = 14), or benign bronchial disease (n = 3). Indicationsfor intervention were hemoptysis (n = 31), symptomatic airwayobstruction (n = 14), and both obstruction and hemoptysis (n = 25). Hemoptysis was stratified as a volume of > 200 mL/d (n = 6), > 50to 200 mL/d (n = 23), or ≤ 50 mL/d but persistence for > 1 week(n = 27). The mean (± SD) duration of hemoptysis was16.5 ± 16.1 days before intervention. Obstruction sites were thetrachea (n = 8), mainstem bronchi (n = 21), and lobar bronchi(n = 30). In 24 cases, the patient had obstructions at multiplesites. The mean size of the pretreatment obstruction was76 ± 24.9%.

Interventions:

APC, a noncontact formof electrocoagulation, was performed via flexible bronchoscopy. Sixtypatients underwent 70 procedures. Conscious sedation with outendotracheal intubation was used in all patients except four, who weremechanically ventilated because of underlying respiratory failure.

Measurements and results

All patients with hemoptysisexperienced a resolution of bleeding immediately after APC. Hemoptysisfrom treated sites did not recur during a mean follow-up duration of97 ± 91.9 days. Patients with endoluminal airway lesions had anoverall decrease in mean obstruction size to 18.4 ± 22.1%. Allpatients with obstructive lesions, except one who died of sepsis, experienced symptom improvement. In these patients, symptom control wasmaintained during a median follow-up period of 53 days (range, 18 to321 days). There were no complications related to the procedure.

Conclusions:

APC is effective for the treatment of endoluminal hemoptysis and airway obstruction. The procedure can beperformed in an outpatient setting or at the bedside in the ICUs. APCprovides a simpler, lower-risk alternative to other interventionalendobronchial techniques.

Section snippets

Materials and Methods

For this study, endobronchial therapy with APC was indicated forpatients with hemoptysis or symptomatic endoluminal airway obstruction. Patients with hemoptysis were eligible for this study if they met allof the following criteria: (1) bleeding originated with in thetracheobronchial tree; (2) the site of bleeding was identifiable duringflexible bronchoscopy; and (3) there was an absence of coagulopathy or other medically correctable causes of hemoptysis. Patients with obstructing airway

Results

From November 1998 to April 2000, 60 patients underwent 70endobronchial APC treatments. Patients' demographic characteristics, diagnoses, and locations of endoluminal airway lesions are shown inTable 1.

Conscious sedation with out endotracheal intubation was used in allpatients except four, who were receiving mechanical ventilation in the ICUs because of respiratory failure caused by their underlying disease. The first author performed all the bronchoscopic interventions. Fifty-seven treatments

Discussion

APC has been used for > 10 years in open surgery,14laparoscopy,15 and GI endoscopy.16 This isthe first study (to our knowledge) that reports on the feasibility and effectiveness of APC for hemostasis and debulking of endoluminaltracheobronchial lesions through the flexible bronchoscope. Theexcellent safety profile, readiness of use, and relatively low costmake APC most suitable for therapeutic applications through theflexible bronchoscope in the outpatient setting. This study alsoattests to the

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    The risks related to APC are similar to those of laser photoresection; Laser therapy has also been shown to be effective in treating endobronchial disease, negating the need for invasive surgery.62,63 Small cases series have shown that APC is safe and effective in treating obstructive airway lesions, both malignant and benign.64–66 It also has been shown to provide benefit in conjunction with chemotherapy in treatment of tuberculosis with evidence of airway lesions.67

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Supported by the Mary L.E. McConnell Fund for Lung Research.

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