Study objective: To evaluate the usefulness of
endobronchial argon plasma coagulation (APC) for the treatment of
hemoptysis and neoplastic airway obstruction.
Setting: Bronchoscopy unit of a
Patients: A total of 60 patients
with bronchogenic carcinoma (n = 43), metastatic tumors affecting the
bronchi (n = 14), or benign bronchial disease (n = 3). Indications
for intervention were hemoptysis (n = 31), symptomatic airway
obstruction (n = 14), and both obstruction and hemoptysis (n = 25).
Hemoptysis was stratified as a volume of > 200 mL/d (n = 6), > 50
to 200 mL/d (n = 23), or ≤ 50 mL/d but persistence for > 1 week
(n = 27). The mean (± SD) duration of hemoptysis was
16.5 ± 16.1 days before intervention. Obstruction sites were the
trachea (n = 8), mainstem bronchi (n = 21), and lobar bronchi
(n = 30). In 24 cases, the patient had obstructions at multiple
sites. The mean size of the pretreatment obstruction was
76 ± 24.9%.
Interventions: APC, a noncontact form
of electrocoagulation, was performed via flexible bronchoscopy. Sixty
patients underwent 70 procedures. Conscious sedation without
endotracheal intubation was used in all patients except four, who were
mechanically ventilated because of underlying respiratory failure.
Measurements and results: All patients with hemoptysis
experienced a resolution of bleeding immediately after APC. Hemoptysis
from treated sites did not recur during a mean follow-up duration of
97 ± 91.9 days. Patients with endoluminal airway lesions had an
overall decrease in mean obstruction size to 18.4 ± 22.1%. All
patients with obstructive lesions, except one who died of sepsis,
experienced symptom improvement. In these patients, symptom control was
maintained during a median follow-up period of 53 days (range, 18 to
321 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 be
performed in an outpatient setting or at the bedside in the ICUs. APC
provides a simpler, lower-risk alternative to other interventional