Clinical Endoscopy

Hybrid argon plasma coagulation in Barrett’s esophagus: a systematic review and meta-analysis: Sagar N. Shah, Nabil El Hage Chehade, Amirali Tavangar, Alyssa Choi, Marc Monachese, Kenneth J. Chang, Jason B. Samarasena; Clin Endosc 2023;56(1):38-49. Published online January 30, 2023; DOI: https://doi.org/10.5946/ce.2022.179

Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: Patients with Barrett’s esophagus are at increased risk of developing esophageal adenocarcinoma. Endoscopic therapies aim to eradicate dysplastic and metaplastic tissues. Hybrid argon plasma coagulation (hybrid-APC) utilizes submucosal fluid injection to create a protective cushion prior to ablation that shields the submucosa from injury. We performed a pooled meta-analysis to evaluate the safety and efficacy of hybrid-APC.
Methods
We conducted a systematic search of major electronic databases in April 2022. Studies that included patients with dysplastic and non-dysplastic Barrett’s esophagus undergoing treatment with hybrid-APC were eligible for inclusion. Outcome measures included complete remission of intestinal metaplasia (CR-IM), stricture formation, serious adverse events, and number of sessions necessary to achieve CR-IM.
Results
Overall pooled CR-IM rate for patients undergoing hybrid-APC was 90.8% (95% confidence interval [CI], 0.872–0.939; I2=0%). Pooled stricture rate was 2.0% (95% CI, 0.005–0.042; I2=0%). Overall serious adverse event rate was 2.7% (95% CI, 0.007–0.055; I2=0%).
Conclusions
Results of the current meta-analysis suggest that hybrid-APC is associated with high rates of CR-IM and a favorable safety profile. Interpretation of these results is limited by the inclusion of retrospective cohort and case series data. Randomized controlled trials that standardize treatment and outcome evaluation protocols are necessary to understand how this treatment option is comparable to the current standards of care.

Citations

Citations to this article as recorded by

High Quality Barrett’s Esophagus Examination & Endoscopic Eradication Therapy
Shirin Dey, Kevin Shah, Srinadh Komanduri
Gastrointestinal Endoscopy Clinics of North America.2025;[Epub] CrossRef
Application of electrosurgery in gastrointestinal endoscopy
Hongrui Wang, Jiuzhou Zhao, Yu Zhou
Progress in Medical Devices.2024;[Epub] CrossRef
Hybrid Argon Plasma Coagulation for Barrett’s Esophagus and for Colonic Mucosal Resection—A Systematic Review and Meta-Analysis
Maria Manuela Estevinho, Rolando Pinho, João Carlos Silva, João Correia, Pedro Mesquita, Teresa Freitas
Biomedicines.2023; 11(4): 1139. CrossRef
Hybrid-APC treatment for gastric vascular ectasia of atypical location after failed radiofrequency ablation
José Manuel Palma García, Raúl Honrubia López, Cristina Fernández de Castro, Carmen Comas Redondo
Revista Española de Enfermedades Digestivas.2023;[Epub] CrossRef
Thermal ablative therapies in the gastrointestinal tract
Hendrik Manner
Current Opinion in Gastroenterology.2023; 39(5): 370. CrossRef
Endoscopic Management of Dysplastic Barrett’s Oesophagus and Early Oesophageal Adenocarcinoma
Leonardo Henry Eusebi, Andrea Telese, Chiara Castellana, Rengin Melis Engin, Benjamin Norton, Apostolis Papaefthymiou, Rocco Maurizio Zagari, Rehan Haidry
Cancers.2023; 15(19): 4776. CrossRef
Critical Decision Making: Technical Aspects of Esophageal Ablation
Felice Schnoll-Sussman
Foregut: The Journal of the American Foregut Society.2023; 3(3): 314. CrossRef

4,460 View
183 Download
5 Web of Science
7 Crossref

Endoscopic Band Ligation Versus Argon Plasma Coagulation in the Treatment of Gastric Antral Vascular Ectasia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Bruno Salomão Hirsch, Igor Braga Ribeiro, Mateus Pereira Funari, Diogo Turiani Hourneaux de Moura, Sergio Eiji Matuguma, Sergio A. Sánchez-Luna, Fabio Catache Mancini, Guilherme Henrique Peixoto de Oliveira, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura; Clin Endosc 2021;54(5):669-677. Published online May 31, 2021; DOI: https://doi.org/10.5946/ce.2021.063

Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: Argon plasma coagulation (APC) is the most commonly used endoscopic treatment for gastric antral vascular ectasia (GAVE). Endoscopic band ligation (EBL) has emerged as an alternative therapy. Our goal was to evaluate the feasibility, efficacy, and safety of APC and EBL for the treatment of GAVE. This is the first systematic review that included only randomized controlled trials (RCTs) on this topic.
Methods
A comprehensive search was performed using electronic databases to identify RCTs comparing APC and EBL for the treatment of GAVE following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.
Results
Four RCTs were included, with a total of 204 patients. EBL was related to higher endoscopic eradication rates risk difference [RD], 0.29; 95% confidence interval [CI] [0.14, 0.44]; I²=0%) and less bleeding recurrence than APC (RD, 0.29; 95% CI [0.15, 0.44]; I²=0%). Patients treated with EBL required fewer blood transfusions (mean difference [MD], 1.49; 95% CI [0.28, 2.71]; I²=96%) and hospitalizations (MD, 0.29; 95% CI [0.19, 0.39]; I²=0%). The number of sessions required for the obliteration of lesions was higher with APC. There was no difference in the incidence of adverse events.
Conclusions
EBL is superior to APC in the treatment of GAVE in terms of endoscopic eradication rates, recurrence of bleeding, and transfusion requirements.

Citations

Citations to this article as recorded by

Management of gastrointestinal bleed in the intensive care setting, an updated literature review
Vignesh K Nagesh, Sai Priyanka Pulipaka, Ruchi Bhuju, Emelyn Martinez, Shruthi Badam, Gomathy Aarthy Nageswaran, Hadrian Hoang-Vu Tran, Daniel Elias, Charlene Mansour, Jaber Musalli, Sanket Bhattarai, Lokeash Subramani Shobana, Tannishtha Sethi, Ritvik Se
World Journal of Critical Care Medicine.2025;[Epub] CrossRef
A case report of gastric antral vascular ectasia treated by endoscopic band ligation combined with lauromacrogol injection
Linbo Chen, Keke Sun, Yukai Chen, Pingping Hu, Qi Lin
Medicine.2025; 104(4): e41235. CrossRef
Safety and efficacy of endoscopic band ligation versus argon plasma coagulation in management of gastric antral vascular ectasia: randomized clinical trial
Esraa Y. M. Swifee, Osman A. Osman, Mohamed O Abdel-Malek, Mohamed A Mekky
The Egyptian Journal of Internal Medicine.2025;[Epub] CrossRef
Endoscopic band ligation versus argon plasma coagulation in the treatment of gastric antral vascular ectasia: systematic review and meta-analysis
Archit Garg, Vishali Moond, Khyati Bidani, Aashi Garg, Arkady Broder, Babu P. Mohan, Douglas G. Adler
Gastrointestinal Endoscopy.2025; 101(6): 1100. CrossRef
Role of Endoscopy in the Diagnosis, Grading, and Treatment of Portal Hypertensive Gastropathy and Gastric Antral Vascular Ectasia
Ali Khalifa, Don C. Rockey
Gastrointestinal Endoscopy Clinics of North America.2024; 34(2): 263. CrossRef
Review article: Upper gastrointestinal bleeding – review of current evidence and implications for management
Dennis L. Shung, Loren Laine
Alimentary Pharmacology & Therapeutics.2024; 59(9): 1062. CrossRef
A delayed gastric antral vascular ectasia: A case report and literature review
Zheke Fang, Jiajie Zhu, Zheng Fang, Qiang Hu, Liangjun Yang
Medicine.2024; 103(52): e40831. CrossRef
Bevacizumab in combination with octreotide rescues a patient with liver cirrhosis, GAVE syndrome and refractory hemorrhage – a case report
Simon Johannes Gairing, Eva Maria Schleicher, Lukas Müller, Christian Labenz, Felix Darstein, Daniel Grimm, Visvakanth Sivanathan, Arndt Weinmann, Marcus-Alexander Wörns, Roman Kloeckner, Michael B. Pitton, Florian Thieringer, Khan Fareed Rahman, Peter Ro
Zeitschrift für Gastroenterologie.2023; 61(03): 275. CrossRef
A Practical Approach to the Management of Gastric Antral Vascular Ectasia
Matthew H. Meyers, Laura Rodriguez, Michael S. Kriss
American Journal of Gastroenterology.2023; 118(9): 1532. CrossRef
Endoscopic Advances in Hepatology
Emma Vanderschueren, Jonel Trebicka, Wim Laleman
Seminars in Liver Disease.2023; 43(02): 176. CrossRef
Comparisons Between Endoscopic Band Ligation, Radiofrequency Ablation and Endoscopic Thermal Therapy for Gastric Antral Vascular Ectasia: A Meta-Analysis
Cheng-Che Che, Sz-Iuan Shiu, Chung-Wang Ko, Yu-Kang Tu, Chung-Hsin Chang
Digestive Diseases and Sciences.2023; 68(9): 3534. CrossRef
An update on the management of non-variceal upper gastrointestinal bleeding
Ali A Alali, Alan N Barkun
Gastroenterology Report.2022;[Epub] CrossRef
Endoscopic band ligation in the treatment of gastric antral vascular ectasia: a systematic review and meta-analysis
Babu P. Mohan, Gregory Toy, Lena L. Kassab, Suresh Ponnada, Saurabh Chandan, Sheeva Parbhu, Shaun Chandna, Douglas G. Adler
Gastrointestinal Endoscopy.2021; 94(6): 1021. CrossRef

6,225 View
261 Download
10 Web of Science
13 Crossref

Is Endoscopic Band Ligation a Superior Treatment Modality for Gastric Antral Vascular Ectasia Compared to Argon Plasma Coagulation?: Neil Robert O’Morain, Helen O’Donovan, Caroline Conlon, Eileen Shannon, Diarmuid Manning, Eoin Slattery; Clin Endosc 2021;54(4):548-554. Published online January 13, 2021; DOI: https://doi.org/10.5946/ce.2020.236

Abstract PDF PubReader ePub

Background
/Aims: Gastric antral vascular ectasia (GAVE) is a rare acquired vascular lesion of the gastric antrum. The most frequent presentation of GAVE is iron deficiency anemia. Endoscopic therapy is the mainstay of treatment. However, there is no consensus regarding the optimal treatment modality.
Methods
A retrospective cohort study was performed on patients with GAVE, including patients receiving endoscopic therapy. Treatment was with either argon plasma coagulation (APC) or endoscopic band ligation (EBL). Basic demographic data, indication for index procedure, number of sessions, and pre- and post-hemoglobin levels were collected. The aim of the study was to compare outcomes across the two treatment modalities.
Results
One hundred and seventeen diagnoses of GAVE were made. Sixty-two patients (53%) required endoscopic treatment for symptomatic GAVE (female, n=38, 61%; mean age of 74.4 years). Two hundred and eighteen procedures were performed during the study period. APC was performed (n=161, 74%) more frequently than EBL (n=57, 26%). Patients treated with APC at index required a median 5 subsequent therapeutic interventions (APC or EBL), while those treated with EBL at index required a further 2.9 treatments (EBL only) (p<0.05).
Conclusions
APC was the most common treatment modality employed. We demonstrate an increasing incidence of EBL. Patients treated with EBL at index treatment required fewer subsequent treatment sessions and had a greater mean rise in hemoglobin. This suggests a more effective endoscopic response with EBL.

Citations

Citations to this article as recorded by

A case report of gastric antral vascular ectasia treated by endoscopic band ligation combined with lauromacrogol injection
Linbo Chen, Keke Sun, Yukai Chen, Pingping Hu, Qi Lin
Medicine.2025; 104(4): e41235. CrossRef
Endoscopic band ligation versus argon plasma coagulation in the treatment of gastric antral vascular ectasia: systematic review and meta-analysis
Archit Garg, Vishali Moond, Khyati Bidani, Aashi Garg, Arkady Broder, Babu P. Mohan, Douglas G. Adler
Gastrointestinal Endoscopy.2025;[Epub] CrossRef
Role of Endoscopy in the Diagnosis, Grading, and Treatment of Portal Hypertensive Gastropathy and Gastric Antral Vascular Ectasia
Ali Khalifa, Don C. Rockey
Gastrointestinal Endoscopy Clinics of North America.2024; 34(2): 263. CrossRef
Comparing Endoscopic Treatment Modalities for Gastric Antral Vascular Ectasia
Manesh Kumar Gangwani, Hossein Haghbin, Fariha Hasan, Julia Dillard, Fouad Jaber, Dushyant Singh Dahiya, Hassam Ali, Faisal Kamal, Umar Hayat, Wade Lee-Smith, Amir Sohail, Sumant Inamdar, Muhammad Aziz, Douglas G. Adler
Journal of Clinical Gastroenterology.2024;[Epub] CrossRef
Snare-tip spray spark coagulation technique for bleeding secondary to gastric antral vascular ectasia
Koudai Hamaguchi, Tatsuma Nomura, Keiichi Ito, Makoto Kobayashi
Endoscopy.2022; 54(10): E562. CrossRef
Gastric Antral Vascular Ectasia (GAVE) a case report, review of the literature and update of techniques
L. Fortuna, A. Bottari, D. Bisogni, F. Coratti, F. Giudici, B. Orlandini, G. Dragoni, F. Cianchi, F. Staderini
International Journal of Surgery Case Reports.2022; 98: 107474. CrossRef
Endoscopic band ligation in the treatment of gastric antral vascular ectasia: a systematic review and meta-analysis
Babu P. Mohan, Gregory Toy, Lena L. Kassab, Suresh Ponnada, Saurabh Chandan, Sheeva Parbhu, Shaun Chandna, Douglas G. Adler
Gastrointestinal Endoscopy.2021; 94(6): 1021. CrossRef

5,673 View
193 Download
4 Web of Science
7 Crossref

Management of Remnant or Recurrent Lesions after Endoscopic Papillectomy: Ichiro Yasuda, Saito Kobayashi, Kosuke Takahashi, Sohachi Nanjo, Hiroshi Mihara, Shinya Kajiura, Takayuki Ando, Kazuto Tajiri, Haruka Fujinami; Clin Endosc 2020;53(6):659-662. Published online December 3, 2019; DOI: https://doi.org/10.5946/ce.2019.171

Abstract PDF PubReader ePub

Endoscopic papillectomy (EP) for ampullary adenomas achieves cure rates ranging from 76% to 90%, and recurrence rates are as high as 33%. If remnant or recurrent lesions after prior EP are endoscopically visible and are not suspected of intraductal extension into the biliary or pancreatic duct, repeated snaring and cutting can be performed until all visible lesions are completely resected. However, endoscopic ablative therapies, particularly argon plasma coagulation, can be attempted for tiny or uncertain remnant and recurrent lesions. In addition, intraductal radiofrequency ablation has recently been attempted for residual intraductal lesions after EP at several institutions. Although still under investigation, it has shown some promise. It might be offered as an alternative to surgery, particularly in patients who are unfit for surgery or those who refuse to undergo surgery.

Citations

Citations to this article as recorded by

Feasibility of performing cryoballoon ablation for treatment of residual ampullary neoplastic lesions using a duodenoscope
Tammy Tran, Anand Kumar
VideoGIE.2025;[Epub] CrossRef
The timing of recurrence after endoscopic papillectomy
Samuel Han, Joshua A. Turkeltaub, Daniel Jonas, Augustin R. Attwell, Anna M. Duloy, Steven A. Edmundowicz, Hazem T. Hammad, Mihir S. Wagh, Sachin Wani, Raj J. Shah
Surgical Endoscopy.2024; 38(2): 688. CrossRef
Outcomes of rescue procedures in the management of locally recurrent ampullary tumors: A Pancreas 2000/EPC study
Elias Karam, Marcus Hollenbach, Einas Abou Ali, Francesco Auriemma, Aiste Gulla, Christian Heise, Sara Regner, Sébastien Gaujoux, Jean M. Regimbeau, Georg Kähler, Steffen Seyfried, Jean C. Vaillant, Charles De Ponthaud, Alain Sauvanet, David Birnbaum, Nic
Surgery.2023; 173(5): 1254. CrossRef
The first Russian experience of radiofrequency ablation in the treatment of adenoma of the major duodenal papilla with intraductal growth in the common bile duct
L.R. Tigiyev, Yu.S. Teterin, P.A. Yartsev, S.S. Petrikov
Pirogov Russian Journal of Surgery.2023; (8): 70. CrossRef
The Significance of Histopathological Findings on Clinical Outcomes in Endoscopic Papillectomy with Endocut
Sayaka Miyamoto, Masahiro Serikawa, Yasutaka Ishii, Yumiko Tatsukawa, Shinya Nakamura, Juri Ikemoto, Yosuke Tamura, Kazuki Nakamura, Masaru Furukawa, Yumiko Yamashita, Noriaki Iijima, Koji Arihiro, Shiro Oka
Journal of Clinical Medicine.2023; 12(21): 6853. CrossRef
Clinical outcomes of endoscopic papillectomy of ampullary adenoma: A multi-center study
Seong Ji Choi, Hong Sik Lee, Jiyeong Kim, Jung Wan Choe, Jae Min Lee, Jong Jin Hyun, Jai Hoon Yoon, Hyo Jung Kim, Jae Seon Kim, Ho Soon Choi
World Journal of Gastroenterology.2022; 28(17): 1845. CrossRef
Endoscopic papillectomy for ampullary adenoma and early adenocarcinoma: Analysis of factors related to treatment outcome and long‐term prognosis
Hiroki Kawashima, Eizaburo Ohno, Takuya Ishikawa, Tadashi Iida, Hiroyuki Tanaka, Kazuhiro Furukawa, Masanao Nakamura, Takashi Honda, Senju Hashimoto, Akihiro Itoh, Masatoshi Ishigami, Yoshiki Hirooka, Mitsuhiro Fujishiro
Digestive Endoscopy.2021; 33(5): 858. CrossRef
Predictive factor of recurrence after endoscopic papillectomy for ampullary neoplasms
Kosuke Takahashi, Eisuke Ozawa, Ichiro Yasuda, Naohiro Komatsu, Hisamitsu Miyaaki, Ken Ohnita, Takuji Yamao, Kazuo Oba, Tatsuki Ichikawa, Kazuhiko Nakao
Journal of Hepato-Biliary-Pancreatic Sciences.2021; 28(7): 625. CrossRef
Management of obstructive jaundice in patients with neoplasms of the major duodenal papilla
Yu.S. Teterin, L.R. Tigiev, P.A. Yartsev, E.V. Stepan, M.L. Rogal, Yu.D. Kulikov
Khirurgiya. Zhurnal im. N.I. Pirogova.2021; (7): 49. CrossRef
Underwater endoscopic papillectomy for residual tumor after endoscopic papillectomy: First report
Yuki Mori, Akira Kurita, Shujiro Yazumi
Digestive Endoscopy.2020;[Epub] CrossRef
Diagnosis and treatment of benign neoplasms of the major duodenal papilla
Yu.S. Teterin, P.A. Yartsev, M.L. Rogal, L.R. Tigiev, N.V. Shavrina, K.A. Nugumanova, E.V. Stepan
Khirurgiya. Zhurnal im. N.I. Pirogova.2020; (11): 32. CrossRef

6,369 View
228 Download
7 Web of Science
11 Crossref

Clinical Outcomes of Argon Plasma Coagulation Therapy for Early Gastric Neoplasms: Kyu Young Kim, Seong Woo Jeon, Hea Min Yang, Yu Rim Lee, Eun Jeong Kang, Hyun Seok Lee, Sung Kook Kim; Clin Endosc 2015;48(2):147-151. Published online March 27, 2015; DOI: https://doi.org/10.5946/ce.2015.48.2.147

Abstract PDF PubReader ePub

Background/Aims

Argon plasma coagulation (APC) has some merits in the treatment of gastric neoplasms including a shorter operative time and fewer complications compared with endoscopic mucosal resection or endoscopic submucosal dissection. However, there are few reports on the outcomes of gastric neoplasms treated using APC. The aim of this study was to evaluate APC in the treatment of early gastric neoplasms in terms of clinical efficacy, safety, and local recurrence.

Methods

We enrolled 28 patients who received APC therapy at the Kyungpook National University Hospital between May 2007 and April 2013. Clinical outcomes were analyzed.

Results

The median follow-up period was 24.8 months (range, 2 to 78). Among the 28 lesions treated using the APC procedure, tumor recurrence was encountered in seven lesions (25.0%). Recurrence was found in 50% (5/10) of single APC cases and 11% (2/18) of rescue APC cases. The mean time to recurrence was 16.1 months (range, 2 to 78). There were no serious APC-related complications such as perforation, bleeding, or infection.

Conclusions

APC therapy can be a useful treatment with a favorable safety profile for patients with early gastric neoplasms. However, further studies are necessary to determine the long-term prognosis of patients undergoing this treatment.

Citations

Citations to this article as recorded by

Argon plasma coagulation versus endoscopic resection for the treatment of gastric adenomas: A systematic review and meta-analysis
Jae Gon Lee, Jin Hwa Park, Sang Pyo Lee, Kang Nyeong Lee
Saudi Journal of Gastroenterology.2025;[Epub] CrossRef
Comparison of Endoscopic Radiofrequency Ablation and Argon Plasma Coagulation in Patients with Gastric Low-Grade Intraepithelial Neoplasia: A Large-Scale Retrospective Study
Nanjun Wang, Ningli Chai, Longsong Li, Huikai Li, Yaqi Zhai, Xiuxue Feng, Shengzhen Liu, Wengang Zhang, Enqiang Linghu, Xiaohua Jiang
Canadian Journal of Gastroenterology and Hepatology.2022; 2022: 1. CrossRef
Long-term Outcomes of Additional Endoscopic Treatments for Patients with Positive Lateral Margins after Endoscopic Submucosal Dissection for Early Gastric Cancer
Tae-Se Kim, Byung-Hoon Min, Yang Won Min, Hyuk Lee, Poong-Lyul Rhee, Jae J. Kim, Jun Haeng Lee
Gut and Liver.2022; 16(4): 547. CrossRef
Post-EMR for colorectal polyps, thermal ablation of defects reduces adenoma recurrence: A meta-analysis
Pujan Kandel, Murtaza Hussain, Deepesh Yadav, Santosh K. Dhungana, Bhaumik Brahmbhatt, Massimo Raimondo, Frank J. Lukens, Ghassan Bachuwa, Michael B. Wallace
Endoscopy International Open.2022; 10(10): E1399. CrossRef
Factors associated with conversion to snare resection during gastric endoscopic submucosal dissection
Su Jin Kim, Cheol Woong Choi, Hyeong Seok Nam, Dae Hwan Kang, Hyung Wook Kim, Su Bum Park, Dae Gon Ryu
Surgical Endoscopy.2020; 34(4): 1585. CrossRef
Thermal Ablation of Mucosal Defect Margins Reduces Adenoma Recurrence After Colonic Endoscopic Mucosal Resection
Amir Klein, David J. Tate, Vanoo Jayasekeran, Luke Hourigan, Rajvinder Singh, Gregor Brown, Farzan F. Bahin, Nicholas Burgess, Stephen J. Williams, Eric Lee, Mayenaaz Sidhu, Karen Byth, Michael J. Bourke
Gastroenterology.2019; 156(3): 604. CrossRef
Ablation of residual gastric tumor by argon plasma coagulation after endoscopic resection
Sooyeon Oh, Sang Gyun Kim, Ji Min Choi, Eun Hyo Jin, Jee Hyun Kim, Jong Pil Im, Joo Sung Kim, Hyun Chae Jung
Surgical Endoscopy.2017; 31(3): 1093. CrossRef
Risk-Stratification Model Based on Lymph Node Metastasis After Noncurative Endoscopic Resection for Early Gastric Cancer
Da Hyun Jung, Cheal Wung Huh, Jie-Hyun Kim, Jung Hwa Hong, Jun Chul Park, Yong Chan Lee, Young Hoon Youn, Hyojin Park, Seung Ho Choi, Sung Hoon Noh
Annals of Surgical Oncology.2017; 24(6): 1643. CrossRef

8,525 View
113 Download
9 Web of Science
8 Crossref

Endoscopic Removal of a Proximally Migrated Metal Stent during Balloon Sweeping after Stent Trimming: Nam Jun Cho, Tae Hoon Lee, Sang-Heum Park, Han Min Lee, Kyung Hee Hyun, Suck-Ho Lee, Il-Kwun Chung, Sun-Joo Kim; Clin Endosc 2013;46(4):418-422. Published online July 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.4.418

Abstract PDF PubReader ePub

Placement of a self-expanding metal stent (SEMS) is an effective method for palliation of a malignant biliary obstruction. However, metal stents can cause various complications, including stent migration. Distally migrated metal stents, particularly covered SEMS, can be removed successfully in most cases. Stent trimming using argon plasma coagulation may be helpful in difficult cases despite conventional methods. However, no serious complications related to the trimming or remnant stent removal method have been reported due to the limited number of cases. In particular, proximal migration of a remnant fragmented metal stent after stent trimming followed by balloon sweeping has not been reported. We report an unusual case of proximal migration of a remnant metal stent during balloon sweeping following stent trimming by argon plasma coagulation. The remnant metal stent was successfully removed with rotation technique using a basket and revised endoscopically.

Citations

Citations to this article as recorded by

Safe and reliable removal of a migrated biliary metal stent with a snare placed over the balloon using the two-devices-in-one-channel method
Kazuya Sumi, Jun Ushio, Hisaki Kato, Akinori Komagata, Yuki Kawasaki, Takayoshi Ito, Haruhiro Inoue
Endoscopy.2025; 57(S 01): E222. CrossRef
Needle-knife papillotomy for removal of impacted fully covered self-expandable metal stent
Pang Yong, Wang Tao, Zhang Hui, Luo Zhu-lin, Xie Chuan, Tian Fu-zhou
iGIE.2025;[Epub] CrossRef
Successful removal of a proximally migrated biliary fully covered self‐expandable metal stent using a sphincterotome
Kazuya Koizumi, Karen Kimura, Ryuhei Jinushi
Digestive Endoscopy.2024; 36(3): 374. CrossRef
Endoscopic Management of a Proximally Migrated Fully Covered SEMS Using the Stent-in-Stent Technique
Arunchai Chang, Varayu Prachayakul
Case Reports in Medicine.2020; 2020: 1. CrossRef
Burning and cutting: a unique technique for management of migrated uncovered metal biliary stents
Shivangi Kothari, Truptesh H. Kothari, Vivek Kaul
VideoGIE.2020; 5(11): 562. CrossRef
Recalcitrant embedded biliary self-expanding metal stents: a novel technique for endoscopic extraction
Marc Bernon, Christo Kloppers, Jessica Lindemann, Jake E.J. Krige, Eduard Jonas
VideoGIE.2019; 4(2): 72. CrossRef
Endoscopic management of internally migrated pancreatic duct stents (with video)
Suryaprakash Bhandari, Atul Sharma, Rajesh Bathini, Amit Maydeo
Indian Journal of Gastroenterology.2016; 35(2): 91. CrossRef

8,215 View
90 Download
7 Crossref

A Case of Argon Plasma Trimming of a Biliary Metallic Stent Causing a Duodenal Obstruction: Jun-Hyung Cho, M.D., Seok Ho Dong, M.D., Chang Hyun Cho, M.D., Jae Young Jang, M.D., Hyo Jong Kim, M.D., Byung-Ho Kim, M.D., Young Woon Chang, M.D. and Rin Chang, M.D.; Korean J Gastrointest Endosc 2011;42(3):195-200. Published online March 28, 2011

Abstract PDF: Metallic stents are being widely used in patients with a malignant obstruction of the biliary tract. The advent of metallic stents was heralded as a solution to the problem of plastic stent occlusion. Metallic stents prolong stent patency by lowering occlusion rates, but they may malfunction for several reasons, including occlusion from tumor ingrowth or migration after the procedure. Distal migration or impaction of metallic stents against the duodenal wall may cause severe complications, including duodenal obstruction, perforation and acute upper gastrointestinal bleeding. Several techniques have been developed to manage distal migration of a biliary metallic stent and remove the malfunctioning stent endoscopically. We report on a 43-year-old male who underwent endoscopic palliative biliary drainage because of obstructive pancreatic head cancer. We transected the distal end of the metallic stent using an argon plasma coagulator, treating the duodenal obstruction without any complications. (Korean J Gastrointest Endosc 2011;42:195-200)

2,235 View
8 Download

A Case of Argon Plasma Coagulation Therapy for Hemorrhagic Radiation-induced Gastritis: Mi Young Jang, M.D., Yong Keun Cho, M.D., Sung Jun Goh, M.D., Min Gyu Park, M.D., Dong Yup Lee, M.D., Yong Woo Seo, M.D., Gum Mo Jung, M.D. and Jin Woong Cho, M.D.; Korean J Gastrointest Endosc 2011;42(1):24-27. Published online January 30, 2011

Abstract PDF: Hemorrhagic radiation-induced gastritis is a rare but serious complication of upper gastrointestinal radiation treatment, and no simple and effective treatment method has yet been developed. Studies on effective treatment methods for achieving hemostasis in patients with hemorrhagic radiation-induced gastritis are necessary, because the new indications for upper gastrointestinal radiotherapy in the field digestive oncology can potentially lead to an increased incidence of radiation- induced gastric vasculopathy. For the first time in Korea and to the best of our knowledge, we report here on a 59-years-old male patient with hemorrhagic gastritis that was induced by external radiotherapy for ampullary adenocarcinoma. This was all well-treated using Argon plasma coagulation (APC). (Korean J Gastrointest Endosc 2011;42:24-27)

2,234 View
19 Download

A Case of Bleeding on the Ampulla of Vater Due to Angiodysplasia in a Patient with End Stage Renal Disease: Sang Bae Kim, M.D., Bu Sug Jun, M.D., Hae Bin Jung, M.D., Hyung Keun Kim, M.D., Young Suk Cho, M.D., Hyun Suk Chae, M.D., Chang Don Lee, M.D. and Sung Soo Kim, M.D.; Korean J Gastrointest Endosc 2010;40(1):41-44. Published online January 30, 2010

Abstract PDF: Gastrointestinal angiodysplasia is one of the causes of acute and chronic gastrointestinal bleeding, and gastrointestinal angiodysplasia makes up 2∼6% of all the cases of upper gastrointestinal bleeding. Bleeding from the ampulla of Vater is very rare. We report here on an unusual case of bleeding from angiodysplasia at the ampulla of Vater in a 58-aged woman with end stage renal failure. This lesion was successfully treated with endoscopic argon plasma coagulation. (Korean J Gastrointest Endosc 2010;40:41-44)

2,326 View
12 Download

A Case of a Removal of Pyloric Stent That Was Partially Embeded in the Mucosa after Temporary Stenting for the Benign Pyloric Stenosis and It Was Removed Using Argon Plasma Coagulation: Joo Yeon Oh, M.D., Jong-Jae Park, M.D., Ja In Park, M.D., Won Woo Lee, M.D., Seung Young Roh, M.D., Hyun-Seok Kang, M.D., Jae Seon Kim, M.D. and Young-Tae Bak, M.D.; Korean J Gastrointest Endosc 2010;40(1):31-35. Published online January 30, 2010

Abstract PDF: Generally, self expandable metallic stents (SEMSs) are widely used for the treatment of malignant gastrointestinal stenosis due to their effectiveness and low complication rate. On the contraty, balloon dilatation or Bougie dilatation is commonly used for treating benign gastrointestinal stenosis as non-invasive methods. However, their such complications such as recurrence, hemorrhage and perforation are problematic when these dilation techniques are used. Temporary placement of a SEMS in a benign gastric outlet obstruction is expected to be a promising therapeutic modality despite of several major complications such as migration. Rarely, stent removal can, on rare occasions, be difficult or cause bleeding or perforation when the stent is embeded in the mucosa due to mucosal hyperplasia at the tips of the stent. We report here on a case of a stent, partially embeded in the mucosa after temporary stenting for treating a benign pyloric stenosis, which was successfully removed using argon plasma coagulation. (Korean J Gastrointest Endosc 2010;40:31-35)

2,186 View
20 Download

Two Cases of Rectal Vascular Ectasia in Patients with Liver Cirrhosis and Who Were Treated by Argon Plasma Coagulation: Woong Park, M.D., Chang Il Kwon, M.D., Young Jun Song, M.D., Han Ul Song, M.D., Ju Hee Oh, M.D., Kwang Hyun Ko, M.D. and Kyu Sung Rim, M.D.; Korean J Gastrointest Endosc 2009;38(3):171-175. Published online March 30, 2009

Abstract PDF: The term "vascular ectasia" is defined to include angiodysplasia, gastric antral vascular ectasia (GAVE) and telangiectasis, and these are the leading causes of acute or chronic gastrointestinal bleeding. We describe here the first 2 Korean cases of GAVE with rectal vascular ectasia in patients with liver cirrhosis. A 70-year-old woman was admitted to the hospital with hematochezia. The finding on endoscopy showed diffuse nonconfluent spots with oozing bleeding on the antrum and several vascular spots with oozing bleeding on the rectum. The lesions were successfully treated by argon plasma coagulation (APC). We report on another case of rectal vascular ectasia in a patient with liver cirrhosis. A 77-year-old man was admitted to the hospital with hematochezia. The findings on colonoscopy showed diffuse vascular spots with oozing bleeding on the rectum. The lesions were successfully treated by APC. These two patients have had no bleeding since their treatment, and they are currently being evaluated by follow-up studies at the outpatient department. (Korean J Gastrointest Endosc 2009;38:171-175)

2,210 View
13 Download

Two Cases of Asymptomatic Pneumoperitoneum after Argon Plasma Coagulation Treatment: Sang Pil Kim, M.D., Suck-Ho Lee, M.D., Jun Young Lee, M.D., Jin Woo Park, M.D., Ji-Young Park, M.D., Chang Kyun Lee, M.D., Il-Kwun Chung, M.D. and Sun-Joo Kim, M.D.; Korean J Gastrointest Endosc 2008;37(5):355-359. Published online November 30, 2008

Abstract PDF: Argon Plasma Coagulation (APC), a new endoscopic hemostatic method of non-contact electrocoagulation, is widely used for ablation of Barrett's esophagus, residual tissue after polypectomy, palliation of malignancy and hemostasis of radiation proctopathy, bleeding peptic ulcers, prevention of esophageal varices. Although a safe and effective procedure, if used inappropriately, side effects such as failure of hemostasis, perforation, asymptomatic submucosal emphysema, and pneumoperitoneum can occur. Perforations progressing to peritonitis require surgery, but a pneumoperitoneum can recover with conservative treatment. Therefore, clinicians should distinguish these two different cases. There are no domestic cases of asymptomatic pneumoperitoneum caused by APC. In two cases treated by endoscopic submucosal dissection of polypectomy and early gastric cancer, asymptomatic pneumoperitoneum occurred after argon plasma coagulation treatment. We present these two cases of asymptomatic pneumoperitoneum treated successfully by conservative treatment without complications. (Korean J Gastrointest Endosc 2008;37:355-359)

2,307 View
16 Download

A Case of a Gastric Bezoar Combined with Superior Mesenteric Artery Syndrome: Min Kyoung Kang, M.D., Chang-Il Kwon, M.D., Ji Eun Lee, M.D., Yong Hun Kim, M.D., Kwang Hyun Ko, M.D., Sung Pyo Hong, M.D., Pil Won Park, M.D. and Hee Jin Kim, M.D.*; Korean J Gastrointest Endosc 2008;37(4):271-275. Published online October 30, 2008

Abstract PDF: Superior mesenteric artery syndrome is caused by compression of the third part of the duodenum between the superior mesenteric artery (SMA) and the aorta. Recently, we experienced a case of a gastric bezoar combined with SMA syndrome. A 58-year-old man presented with upper abdominal pain, bloating and weight loss of 5 kg. An endoscopic examination identified a huge gastric bezoar. The bezoar was broken and fragmented into small pieces using an argon plasma coagulator and endoscopic snare catheter. Hypotonic duodenography showed a longitudinal linear band that was presumed to be a vascular impression of the third portion of the duodenum and contrast-enhanced spiral CT showed a reduced distance of 8.4 mm but a normal angle of 38.5^o between the arota and the SMA. A second endoscopic examination demonstrated prominent pulsations that compressed the duodenal wall at the third portion. Luminal expansion with full inflation of air was not attempted under endoscopy. (Korean J Gastrointest Endosc 2008;37:271-275)

2,391 View
16 Download

Trial of Argon Plasma Coagulation in Patients with Heterotopic Gastric Mucosa Presenting with Laryngopharyngeal Symptoms: Chan Ik Park, M.D., Jung Ar Shin, M.D., In Su Jung, M.D. and Hyojin Park, M.D.; Korean J Gastrointest Endosc 2008;36(2):74-77. Published online February 27, 2008

Abstract PDF: Heterotopic gastric mucosa in the upper esophagus, in which the inlet patch is a salmon-colored valvet patch, is located mainly below the upper esophageal sphincter. The acid secretion and inflammation from heterotopic gastric mucosa causes laryngopharyngeal symptoms. Generally, the management of heterotopic gastric mucosa depends on the symptoms, and the condition is generally treated by proton pump inhibitor. Recently, it was reported that argon plasma coagulation (APC) is effective when medical treatment fails. A 49-year-old man and a 44-year-old woman with symptoms of globus sensation and hoarseness visited this clinic. An upper gastrointestinal endoscopy showed a flat salmon-colored patch located at the upper esophagus. The former patient failed medical treatment and the latter did not require long term medical treatment. Therefore, the patients were treated with APC, which resulted in an improvement in symptoms. APC treatment may improve the symptoms of patients with heterotopic gastric mucosa of the cervical esophagus. (Korean J Gastrointest Endosc 2008;36:74-77)

1,982 View
17 Download

A Case of Hereditary Hemorrhagic Telangiectasia Treated by Argon Plasma Coagulation: Min Kyu Jung, M.D., Ju Young Lee, M.D., Hyun Chaol Lee, M.D., Seong Woo Jeon, M.D., Chang Min Cho, M.D., Won Young Tak, M.D. and Young Oh Kweon, M.D.; Korean J Gastrointest Endosc 2008;36(1):14-17. Published online January 30, 2008

Abstract PDF: Rendu-Osler-Weber disease is characterized by hereditary transmission, and by the presence of multiple telangiectases of the skin, mucous membranes, and internal organs. We present a case of Rendu-Osler-Weber disease with bleeding from gastric telangiectases that was successfully treated by endoscopy with the use of argon plasma coagulation (APC). A 65-year-old woman presented with melena. Endoscopy disclosed multiple telangiecatses in the whole stomach. APC was performed at an output of 50 W and with an argon gas flow rate of 2 L/min. Only multiple ulcers at the treated sites were seen 7 days after the procedure and fibrotic scars with contracted mucosal folds without active bleeding signs were noted 2 months later. (Korean J Gastrointest Endosc 2008;36:14-17)

2,134 View
15 Download

The Clinical Effect of Supplementary Argon Plasma Coagulation after Endoscopic Mucosal Piecemeal Resection of a Gastric Adenoma and Carcinoma: Sang Joon Park, M.D., Kee Myung Lee, M.D., Deok Ki Kim, M.D., Sung Jae Sin, M.D., Jae Ho Jung, M.D., Sung Hyeon Jung, M.D., Byeong Moo Yoo, M.D., Ki Baik Hahm, M.D. and Jin Hong Kim, M.D.; Korean J Gastrointest Endosc 2007;34(6):291-297. Published online June 30, 2007

Abstract PDF: Background/Aims: This study was designed to determine the effect of supplementary argon plasma coagulation (APC) after piecemeal resection of a gastric adenoma or an intramucosal adenocarcinoma. Methods: Cases of 62 lesions of 56 consecutive patients with either a gastric adenoma or carcinoma were retrospectively reviewed at the Ajou University Medical Center. APC was performed after an endoscopic complete resection using the piecemeal method of endoscopic mucosal resection (EMR) for patients in the EMR-APC group. For patients in the EMR group, APC was not performed. Results: There was no significant difference in the recurrence rate of the cancers for both groups (9.7%, for the EMR group, 6.5% for the EMR-APC group). The recurrence rate of a low grade dysplasia was 6.7% (EMR group) and 6.3% (EMR-APC group) (p=1.000), the recurrence rate for a high grade dysplasia was 11.1% (EMR group) and 25.0% (EMR-APC group) (p=1.000), and the recurrence rate for an intramucosal adenocarcinoma was 14.3% (EMR group) and 0% (EMR-APC group) (p=0.389). The recurrence rates of lesions in which the lesion size was less than 20 mm and over 20 mm for each group were 6.7% and 9.1% (EMR group) (p=1.000) versus 12.5% and 0% (EMR-APC group) (p=0.520). There was also no significant statistical difference in the recurrence rates for both groups according to the location and macroscopic type of lesion. Conclusions: Supplementary treatment with APC could not significantly reduce the recurrence rate after complete piecemeal resection determined macroscopically. A large- scale and prospective study is necessary to elucidate the clinical significance of supplementary APC for gastric neoplasm treatment.

2,600 View
11 Download

A Case of Condyloma Acuminatum Treated by Argon Plasma Coagulation: Hyon Uk Ryu, M.D., Se Young Lee, M.D., Young Deuk Youn, M.D., Ju Chun Yeo, M.D., Sae Rom Kim, M.D., Young Lan Kwon, M.D., Jun Chul Kim, M.D., Byung Jun Kang, M.D., Chang Keun Park, M.D., Sang Mun Lee, M.D. and Mi Jin Gu, M.D.*; Korean J Gastrointest Endosc 2006;33(5):318-321. Published online November 30, 2006

Abstract PDF: Condyloma acuminatum (CA) is a common sexually transmitted disease caused by the human papillomavirus. In gastrointestinal practice, we generally encounter this disease in the anal canal but rarely in the rectum during a colonoscopy. There are many therapeutic options for CA including chemical or physical destruction, immunological therapy, or a surgical excision. All these procedures have some degree of limitations such as limited clearance rate, high recurrence rate, long duration of therapy, bleeding, release of potentially infectious aerosols, scarring etc. With argon plasma coagulation (APC), which is more available than lasers in gastrointestinal practice, a high frequency current flows through the argon plasma to the tissue, allowing well-controlled superficial tissue destruction without any direct contact between the probe and the tissue. We present a case of anal CA that was treated successfully with APC during a colonoscopy with no recurrence during the follow up. (Korean J Gastrointest Endosc 2006;33:318⁣321)

2,588 View
22 Download

A Case of Huge Gastric Angiodysplasia Treated with Argon Plasma Coagulation: Sung-Jin Moon, M.D., Jin Il Kim, M.D., Jae Kyu Chung, M.D., Min Kuk Kim, M.D., Dae Young Cheung, M.D., Se Hyun Cho, M.D., Soo-Heon Park, M.D., Joon-Yeol Han, M.D., Jae Kwang Kim, M.D. and Kyu Yong Choi, M.D.; Korean J Gastrointest Endosc 2006;33(5):289-293. Published online November 30, 2006

Abstract PDF: Gastric angiodysplasia is an uncommon cause of upper gastrointestinal blood loss that may occur in the stomach or duodenum, and is responsible for up to 1∼6% of upper gastrointestinal bleeding. In contrast to colonic angioectasia, gastric lesions are more common in young individuals and originate from developmental causes. On an endoscopic examination, the lesions typically show a spider-shape or coral reef-like pattern of dilated and tortuous vessels and measure approximately 2 to 10 mm in diameter. We encountered a case of huge gastric angiodysplasia that presented with overt bleeding and anemia and was successfully treated with argon plasma coagulation. (Korean J Gastrointest Endosc 2006;33: 289⁣293)

2,302 View
10 Download

A Case of Zenker's Diverticulum Treated by Argon Plasma Coagulation: Jin Nam Kim, M.D., Jong-Jae Park, M.D., Seung Young Kim, M.D., Jae Youn Park, M.D., Moon Kyoung Joo, M.D., Jin Soo Chang, M.D., Do Won Choi, M.D., Seong Nam Oh, M.D., Woo Sik Han, M.D., Youn Ho Kim, M.D., Jae Seon Kim, M.D. and Young-Tae Bak, M.D.; Korean J Gastrointest Endosc 2006;33(3):159-162. Published online September 30, 2006

Abstract PDF: Zenker's diverticulum occurs mainly in elderly patients with typical symptoms including dysphagia, regurgitation, chronic cough, aspiration, and weight loss. A diagnosis is easily established on upper endoscopy or barium studies. The treatment is surgery or endoscopic cricopharyngeal myotomy. Endoscopic procedures include staple assisted diverticulostomy, CO₂ laser, transparent oblique-endhood attached endoscopic diverticulostomy, and argon plasma coagulation. Minimally invasive endoscopic treatments are associated with a shorter operating time, shorter postoperative hospital stay, quicker resumption of oral intake, and fewer overall complications. Argon plasma coagulation can be performed in any regular endoscopy unit and is less invasive, economical, faster, and well-tolerated. In particular, older patients in a poor general condition, at high surgical risk or with contraindications to general anesthesia can be treated with argon plasma coagulation. (Korean J Gastrointest Endosc 2006;33:159⁣162)

2,111 View
11 Download

Controlled Comparison of Endoscopic Epinephrine Injection and Endoscopic Argon Plasma Coagulation for the Treatment of Acute Peptic Ulcer Bleeding: Kyung Im Pae, M.D., Sang Hyuk Lee, M.D., Hee Kim, M.D., Sang Bong Lee, M.D., Jae Ho Lee, M.D., Sung Jae Park, M.D., Sam Ryong Jee, M.D., Eun Taek Park, M.D., Yeon Jae Lee, M.D., Sang Young Seol, M.D. and Jung Myung Chung, M.D.; Korean J Gastrointest Endosc 2006;32(4):239-245. Published online April 30, 2006

Abstract PDF: Background
/Aims: Endoscopic injection therapy with hypertonic saline Epinephrine (HSE) is the easiest and most widely used procedure for the management of peptic ulcer bleeding. Argon plasma coagulation (APC) is a recently introduced endoscopic hemostatic procedure. Thus, we performed a prospective trial to compare the hemostatic efficacy of APC and HSE. Methods: Forty patients with the diagnosis of bleeding ulcer were randomly assigned to receive either HSE (n=20) or APC (n=20) treatment during the period of September 2003 to April 2004. The two groups were matched for gender, age, site of bleeding, the endoscopic findings and the initial hemoglobin at the study baseline. Results: The bleeding was initially controlled in 18 patients (90%) of the APC group, and in 20 patients (100%) of the HSE group. Rebeeding occurred in one patient (5%) of the APC group and in 3 patients (15.5%) of the HSE group. The lengths of stay in the hospital were 11.7 days in the APC group and 10.7 days in the HSE group. Death occurred in 1 case in the APC group and in 1 case in the HSE group. The initial hemostatic efficacy showed no difference between the two groups. Conclusions: Argon plasma coagulation is as effective as hypertonic saline epinephrine injection for the initial management of acute peptic ulcer bleeding. (Korean J Gastrointest Endosc 2006;32:239⁣245)

2,088 View
12 Download

The Effects of Endoscopic Sodium Alginate Powder (Alto Shooter^TM) in Peptic Ulcer Bleeding: Ilhyun Baek, M.D., Heung Young Oh, M.D., Gwang Ho Baik, M.D., Taeho Hahn, M.D., Jin Bae Kim, M.D., Jin Lee, M.D. and Myung Seok Lee, M.D.; Korean J Gastrointest Endosc 2004;29(6):489-494. Published online December 30, 2004

Abstract PDF: Background
/Aims: Peptic ulcer bleeding can be treated by endoscopic laser, argon plasma coagulation, heater probe, or electrocoagulation. However, techinical difficulties and significant rebleeding rate after such endoscopic hemostasis, offer some beneficial effect of Alto Shooter^TM as an adjuvant therapy in active peptic ulcer bleeding. Methods: Twenty-three patients with active peptic ulcer bleeding were randomized to Alto Shooter^TM & argon plasma coagulation therapy (ALTO⁢APC) or argon plasma coagulation therapy alone (APC). Forrest classifications were used to compare the effect of bleeding control. Results: The Forrest classifications in two groups before treatment were Ib (6 patients), IIa (11 patients) in "ALTO⁢APC", Ib (2 patients) and IIa (4 patients) in "APC". The Forrest classifications of two groups at follow-up endoscopy were Ia (1 patient), Ib (1 patient), IIc (14 patients), III (1 patient) in "ALTO⁢APC" and IIc (6 patients) in "APC". There was no significant difference in hemostatic effect between "ALTO⁢APC" (p=0.001) and "APC" (p=0.001) groups. Conclusions: Alto Shooter^TM offers no advantage over conventional endoscopic argon plasma coagulation therapy in controlling active peptic ulcer bleeding. Therefore routine addition of Alto Shooter^TM treatment may not be recommended after initial successful endoscopic argon plasma coagulation therapy in active peptic ulcer bleeding. (Korean J Gastrointest Endosc 2004;29:489⁣494)

2,515 View
38 Download

소화성 궤양 출혈에서 Argon Plasma Coagulation 의 내시경적 지혈 효과: Korean J Gastrointest Endosc 2001;23(5):387-387. Published online November 30, 2000

PDF

1,436 View
4 Download

Search