Apc

The principle of APC is the conduction of high frequency monopolar alternating current to target tissues through ionized argon plasma. Electrons flow through a channel of electrically activated ionized argon gas from the probe electrode to the targeted tissue causing thermal coagulation at the interface. As the tissue surface loses its electrical conductivity because of desiccation, the plasma stream shifts to adjacent nondesiccated (conductive) tissue.

The APC probe is a flexible Teflon tube with a tungsten electrode contained in a ceramic nozzle at its tip.

Coagulation depth is dependent on the generator power setting, the duration of application, and the distance from the probe tip to the target tissue. The operative distance between the probe and the tissue ranges from 2 to 8 mm. The argon arc contacts the tissue closest to the electrode allowing for direct or tangential coagulation. Probes are available that direct the plasma parallel (end-firing) or perpendicular (side-firing) to the axis of the catheter.

We prefer the end-firing probes. Pulsed APC delivery modes may offer a more precise application of the argon beam. Cipolletta and colleagues (1998) compared APC with HP in a small group of patients (n = 41) with bleeding peptic ulcers. Initial hemostasis, recurrent bleeding, and emergency surgery rates were comparable in both groups. Chau and colleagues (2003) in a larger trial, compared APC with HP plus injection therapy for bleeding peptic ulcers. Although a statistically significant difference was not observed, the sample size was not large enough to demonstrate a significant benefit over standard therapy.

APC has also been compared with epinephrine (1:10,000) plus polidocanol (1%) injection. Recurrent bleeding and mortality rates were similar in both groups; however, this study was also limited by its small sample size (n = 80).

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