Argon plasma coagulation: Clinical experience in pediatric patients

Background: Argon plasma coagulation has potential advantages in pediatric endoscopy. Methods: Argon plasma coagulation was applied in 13 children (age 0.05-17 years; median 3 years) with significant comorbid conditions including immunosuppression, chemotherapy, acute or chronic organ failure, and coagulopathy. Twelve had bleeding lesions; esophageal granulomatous tissue was coagulated in one. The bleeding lesion was located in the stomach in 9 of 12, the duodenum in 2 of 12 (both with granulomatous tissue), and at an enterocolonic anastomosis in 1 of 12. Observations: In total, 23 procedures were performed, 22 for bleeding (range 1-5 per patient). Hemostasis was achieved in 8 of 12 with one session. Blood loss and transfusion requirement were reduced in 3 of the other 4 patients. Blood loss was not affected in 1. Bleeding recurred in 3 of 12, and additional procedures were performed in 7 of 12. Granulomatous tissue was completely eradicated in 2 of 3; in one, granulomatous tissue associated with surgical staples was only partially removed. Complications occurred in 2 of 13 patients and included submucosal argon gas and scar formation. Conclusion: Endoscopic argon plasma coagulation is efficacious for hemostasis and tissue ablation in pediatric patients. Minor complications occurred in 17% (2/13) of cases in this series.