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Ablation of residual gastric tumor by argon plasma coagulation after endoscopic resection



For residual gastric tumors (RT) found at the treated sites after endoscopic resections (ER), additional treatment options are additional ER, surgery or argon plasma coagulation (APC). Long-term efficacy of APC as the curative modality for RT has not been fully elucidated. This study aimed to investigate the efficacy and long-term outcome of APC for RT with relevant tumor factors.


Eighty-two patients who received ER for gastric adenocarcinoma or adenoma and were subsequently treated with APC for RT were reviewed retrospectively. Characteristics of the tumors curatively ablated with single-session of APC and the non-curatively ablated were compared by multiple logistic regression analysis. Overall rate of curative ablation and follow-up duration was calculated.


Initial tumor size <20 mm [odds ratio for second residual recurrence (OR) 0.16; 95 % confidence interval (CI) 0.039–0.63], en-bloc resection (OR 0.16; 95 % CI 0.039–0.72), histologic complete resection (OR 0.14; 95 % CI 0.028–0.66) and RT with flat or depressed type (OR 0.20; 95 % CI 0.051–0.77) were significantly associated with curative ablation of RT by single-session of APC. Anterior wall or lesser curvature location showed a tendency toward curative APC, but not reached statistical significance (OR 0.36; 95 % CI 0.11–1.16). A total of 60 patients (73.2 %) achieved curative ablation after single-session of APC. Eleven among the patients (n = 22) with second or more residual recurrence achieved curative ablation with one or two more additional sessions of APC. Overall rate of curative ablation was 86.6 % (71/82). From the last APC, the final curative ablation group (n = 71) has been followed up for 49.7 ± 37.4 months.


En-bloc resection, histologic complete resection, RT with flat or depressed type and initial tumor size less than 2 cm can be predictors of favorable clinical outcome of APC as an additional treatment for RT. For selected patients with RT, APC and close monitoring could be a reasonable alternative to immediate resection.

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  1. 1.

    Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136:E359–E386

  2. 2.

    Choi J, Kim SG, Im JP, Kim JS, Jung HC (2015) Long-term clinical outcomes of endoscopic resection for early gastric cancer. Surg Endosc 29:1223–1230

  3. 3.

    Min BH, Kim ER, Kim KM, Park CK, Lee JH, Rhee PL, Kim JJ (2015) Surveillance strategy based on the incidence and patterns of recurrence after curative endoscopic submucosal dissection for early gastric cancer. Endoscopy 47:784–793

  4. 4.

    Hahn KY, Park JC, Kim EH, Shin S, Park CH, Chung H, Shin SK, Lee SK, Lee YC (2016) Incidence and impact of scheduled endoscopic surveillance on recurrence after curative endoscopic resection for early gastric cancer. Gastrointest Endosc. doi:10.1016/j.gie.2016.03.1404 (Epub ahead of print)

  5. 5.

    Bae SY, Jang TH, Min BH, Lee JH, Rhee PL, Rhee JC, Kim JJ (2012) Early additional endoscopic submucosal dissection in patients with positive lateral resection margins after initial endoscopic submucosal dissection for early gastric cancer. Gastrointest Endosc 75:432–436

  6. 6.

    Hoteya S, Iizuka T, Kikuchi D, Mitani T, Matsui A, Ogawa O, Furuhata T, Yamashta S, Yamada A, Kaise M, Yahagi N (2014) Secondary endoscopic submucosal dissection for residual or recurrent tumors after gastric endoscopic submucosal dissection. Gastric Cancer 17:697–702

  7. 7.

    Sagawa T, Takayama T, Oku T, Hayashi T, Ota H, Okamoto T, Muramatsu H, Katsuki S, Sato Y, Kato J, Niitsu Y (2003) Argon plasma coagulation for successful treatment of early gastric cancer with intramucosal invasion. Gut 52:334–339

  8. 8.

    Murakami M, Nishino K, Inoue A, Takaoka Y, Iwamasa K, Murakami B, Tanabe S (2004) Argon plasma coagulation for the treatment of early gastric cancer. Hepatogastroenterology 51:1658–1661

  9. 9.

    Kitamura T, Tanabe S, Koizumi W, Mitomi H, Saigenji K (2006) Argon plasma coagulation for early gastric cancer: technique and outcome. Gastrointest Endosc 63:48–54

  10. 10.

    Lee KM, Kim YB, Sin SJ, Jung JY, Hwang JC, Lim SG, Yoo BM, Kim JH, Cho SW (2009) Argon plasma coagulation with submucosal saline injection for gastric adenoma on outpatient basis. Dig Dis Sci 54:2623–2628

  11. 11.

    Tomita T, Arai E, Kohno T, Kondo T, Kim Y, Oshima T, Hori K, Watari J, Matsumoto T, Miwa H (2011) Outcomes of treatment of argon plasma coagulation therapy in elderly or high-risk patients with early gastric cancer: a comparison of outcomes among experienced and nonexperienced endoscopists. J Clin Gastroenterol 45:e54–e59

  12. 12.

    Ahn JY, Choi KD, Na HK, Choi JY, Kim MY, Choi KS, Lee JH, Kim FH, Song HJ, Lee GH, Jung HY, Kim JH, Han S (2013) Clinical outcomes of argon plasma coagulation for the treatment of gastric neoplasm. Surg Endosc 27:3146–3152

  13. 13.

    Jung SJ, Cho SJ, Choi IJ, Kook MC, Kim CG, Lee JY, Park SR, Lee JH, Ryu KW, Kim YW (2013) Argon plasma coagulation is safe and effective for treating smaller gastric lesions with low-grade dysplasia: a comparison with endoscopic submucosal dissection. Surg Endosc 27:1211–1218

  14. 14.

    Kim KY, Jeon SW, Yang HM, Lee YR, Kang EJ, Lee HS, Kim SK (2015) Clinical outcomes of argon plasma coagulation therapy for early gastric neoplasms. Clin Endosc 48:147–151

  15. 15.

    Yoon H, Kim SG, Choi J, Im JP, Kim JS, Kim WH, Jung HC (2013) Risk factors of residual or recurrent tumor in patients with a tumor-positive resection margin after endoscopic resection of early gastric cancer. Surg Endosc 27:1561–1568

  16. 16.

    Han JP, Hong SJ, Kim HK, Lee YN, Lee TH, Ko BM, Cho JY (2016) Risk stratification and management of non-curative resection after endoscopic submucosal dissection for early gastric cancer. Surg Endosc 30:184–189

  17. 17.

    Inoue H, Takeshita K, Hori H, Muraoka Y, Yoneshima H, Endo M (1993) Endoscopic mucosal resection with a cap-fitted panendoscope for esophagus, stomach, and colon mucosal lesions. Gastrointest Endosc 39:58–62

  18. 18.

    Kang HY, Kim SG, Kim JS, Jung HC, Song IS (2010) Clinical outcomes of endoscopic submucosal dissection for undifferentiated early gastric cancer. Surg Endosc 24:509–516

  19. 19.

    Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14:101–112

  20. 20.

    Takenaka R, Kawahara Y, Okada H, Hori K, Inoue M, Kawano S, Tanioka D, Tsuzuki T, Yagi S, Kato J, Uemura M, Ohara N, Yoshino T, Imagawa A, Fujiki S, Takata R, Yamamoto K (2008) Risk factors associated with local recurrence of early gastric cancers after endoscopic submucosal dissection. Gastrointest Endosc 68:887–894

  21. 21.

    Jang JS, Choi SR, Qureshi W, Kim MC, Kim SJ, Jeung JS, Han SY, Noh MH, Lee JH, Lee SW, Baek YH, Kim SH, Choi PJ (2009) Long-term outcomes of endoscopic submucosal dissection in gastric neoplastic lesions at a single institution in South Korea. Scand J Gastroenterol 44:1315–1322

  22. 22.

    Lian J, Chen S, Zhang Y, Qiu F (2012) A meta-analysis of endoscopic submucosal dissection and EMR for early gastric cancer. Gastrointest Endosc 76:763–770

  23. 23.

    Sekiguchi M, Suzuki H, Oda I, Abe S, Nonaka S, Yoshinaga S, Taniguchi H, Sekine S, Kushima R, Saito Y (2014) Risk of recurrent gastric cancer after endoscopic resection with a positive lateral margin. Endoscopy 46:273–278

  24. 24.

    Chung SJ, Park MJ, Kang SJ, Kang HY, Chung GE, Kim SG, Jung HC (2012) Effect of annual endoscopic screening on clinicopathologic characteristics and treatment modality of gastric cancer in a high-incidence region of Korea. Int J Cancer 131:2376–2384

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This work was supported by a Grant from the Liver Research Institute, Seoul National University College of Medicine and Promising-Pioneering Researcher Program through Seoul National University in 2015.

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Correspondence to Sang Gyun Kim.

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Drs. Sooyeon Oh, Sang Gyun Kim, Ji Min Choi, Eun Hyo Jin, Jee Hyun Kim, Jong Pil Im, Joo Sung Kim, Hyun Chae Jung have no conflicts of interest or financial ties to disclose.

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Oh, S., Kim, S.G., Choi, J.M. et al. Ablation of residual gastric tumor by argon plasma coagulation after endoscopic resection. Surg Endosc 31, 1093–1100 (2017). https://doi.org/10.1007/s00464-016-5069-5

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  • Gastric cancer
  • Residual tumor
  • Argon plasma coagulation
  • Endoscopic resection