Hybrid-argon plasma coagulation for superficial esophageal cancer at risk of airway obstruction: a case report

Abstract

Figures

a The APC catheter was positioned in contact with the mucosal surface. b A submucosal fluid cushion was created using a high-pressure, needleless injection. c Following the injection, thermal ablation was performed on the ESCC. d The presence of a submucosal cushion may help enhance the safety of the thermal ablation procedure. Adapted from Hattori A, Ikenoyama Y, Fujiwara Y, et al. Endoscopy 2025; 57: E987–E988. APC, argon plasma coagulation; ESCC, esophageal squamous cell carcinoma.

Significant laryngeal edema was observed during endoscopic evaluation.

a ESCC was detected in the mid-thoracic esophagus. b The lesion margins were initially marked using H-APC. c Following lesion marking, a submucosal cushion was created by injecting a saline solution mixed with indigo carmine using H-APC. d ESCC was being cauterised using H-APC. e Initial coagulation with H-APC facilitated the detachment of the superficial squamous epithelium. The loosened epithelial layer was then easily removed using the endoscope. f A second submucosal injection was subsequently administered using H-APC, and coagulation was reapplied to enhance submucosal ablation. ESCC, esophageal squamous cell carcinoma; H-APC, hybrid argon plasma coagulation.

Full text

Endoscopic submucosal dissection (ESD) is the standard treatment for superficial esophageal squamous cell carcinoma (ESCC). However, this procedure is associated with complications and a relatively long procedure time 1 . Argon plasma coagulation (APC) is a technically simple treatment for ESCC, but APC can sometimes cause esophageal perforation or stricture 2 3 . Hybrid APC (H-APC), which combines APC with high-pressure submucosal injection, has recently been developed. This technique enables controlled coagulation with improved safety and precision ( 4 5 Fig. 1 ).

a The APC catheter was positioned in contact with the mucosal surface. b A submucosal fluid cushion was created using a high-pressure, needleless injection. c Following the injection, thermal ablation was performed on the ESCC. d The presence of a submucosal cushion may help enhance the safety of the thermal ablation procedure. Adapted from Hattori A, Ikenoyama Y, Fujiwara Y, et al. Endoscopy 2025; 57: E987–E988. APC, argon plasma coagulation; ESCC, esophageal squamous cell carcinoma.

A 59-year-old male patient was diagnosed with superficial ESCC with significant laryngeal edema due to a prior history of radiation therapy for laryngeal cancer. Due to the high risk of airway obstruction associated with prolonged sedation, H-APC was selected as a simpler and faster treatment for ESCC ( Fig. 2 ).

Significant laryngeal edema was observed during endoscopic evaluation.

A thin-diameter endoscope (EG-840TP; Fujifilm, Tokyo, Japan) was used because of pharyngeal stenosis caused by prior radiation. Following lesion marking, a submucosal cushion was created using H-APC by injecting a saline solution mixed with indigo carmine. Thermal coagulation was performed using the pulsed APC slow 5.0 (ERBE JET2, effect 40). Initial coagulation with H-APC facilitated the detachment of the superficial squamous epithelium. The loosened epithelial layer was then easily removed using an endoscope. A second submucosal injection was subsequently administered using H-APC, and coagulation was reapplied to enhance submucosal ablation. The procedure time from the initial submucosal injection to the completion of coagulation was 8 minutes ( Fig. 3 , Video 1 ). No immediate complications, such as perforations, were observed. Follow-up endoscopy at 2 months showed complete scar formation with no endoscopic evidence of residual or recurrent lesions.

a ESCC was detected in the mid-thoracic esophagus. b The lesion margins were initially marked using H-APC. c Following lesion marking, a submucosal cushion was created by injecting a saline solution mixed with indigo carmine using H-APC. d ESCC was being cauterised using H-APC. e Initial coagulation with H-APC facilitated the detachment of the superficial squamous epithelium. The loosened epithelial layer was then easily removed using the endoscope. f A second submucosal injection was subsequently administered using H-APC, and coagulation was reapplied to enhance submucosal ablation. ESCC, esophageal squamous cell carcinoma; H-APC, hybrid argon plasma coagulation.

Hybrid argon plasma coagulation (H-APC) procedure for superficial esophageal squamous cell carcinoma.Video 1

H-APC was performed safely and efficiently. H-APC could potentially serve as an effective therapeutic option for ESCC cases that are challenging to manage with ESD.

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