To evaluate the effectiveness and safety of argon plasma coagulation (APC) via flexible bronchoscopy (FFB) for the management of both benign and malignant airway lesions.
Retrospective review of consecutive case records of all patients treated at the Singapore General Hospital with APC via FFB from May 2002 to December 2004.
A total of 35 patients underwent 41 procedures, all of which were performed via flexible bronchoscopy under conscious sedation. Mean age was 62.4±16.4years, of whom 25/35 (71.4%) were male. Of the 41 procedures, 25/41 (61%) were performed on an outpatient basis. 2/41 (4.9%) of patients were in the intensive care unit requiring mechanical ventilation for respiratory failure. Majority of patients 27/35 (77.1%) had malignant endobronchial lesions. The remaining 8/35 (22.9%) patients had benign airway lesions due to granulation tissue or benign strictures causing airway obstruction. The mean APC procedure time was 32.7±20minutes. There was no procedure-related morbidity or mortality. All patients experienced immediate symptomatic improvement in their dyspnoea. The 2 patients who required mechanical ventilation could be weaned off the ventilator immediately post procedure and eventually discharged home. Repeat APC procedures were required in 4 patients (2 patients needed 2 procedures, 2 patients needed 3 procedures) to maintain airway patency. The median time between each procedure was 63days (range 23-288days). Five patients proceeded on to have rigid bronchoscopy (with or without NdYAG laser application and stent deployment) for further management of their airway obstruction.
APC can be used to help restore airway patency for both the palliation of airway obstruction in malignant diseases and treatment of benign lesions. It is a safe, simple, and economic alternative to the current available array of therapeutic bronchoscopic modalities. However, repeated procedures may be required to maintain airway patency.
APC is a useful adjunct for the management of both benign and malignant airway problems which can be safely and effectively performed via FFB under conscious sedation.
Su-Ying Low, None.