APC is a noncontact thermal technique that limits the maximal coagulation depth to less than 2 to 3 mm (Figures 22-1 and 22-2). The existence of both side and forward viewing APC probes permits more precise targeting of the malignant tissue. The major disadvantage is its limited depth of penetration requiring several sessions. Due to the limited depth of thermal effect, bulky tumors cannot be effectively treated by APC. APC is effective in ablating residual tissues and achieving hemostasis with low risk of perforation (0.5%). In one study on advanced ECs, APC in conjunction with endoscopic balloon dilatation achieved a success rate of 84% within 2 treatment sessions in the palliation of dysphagia (Heindorff et al, 1998). The perforation rate in this study was 8%, which is comparable to laser therapy. The relative high perforation rate is likely due to the adjunctive use of balloon dilatation. In addition, APC is particularly useful in managing malignant and hyperplastic tissue overgrowth/ingrowth associated with the use of an esophageal stent. Compared to Nd:YAG laser therapy, which may destroy the metal meshes, APC generally does not damage the stent. However, there are reports using APC endoluminally to cut the nitinol stents. The major advantages of APC over laser therapy include relatively low equipment costs and tangential delivery of thermal energy.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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