Endoscopic Treatment of Esophageal Varices: Endoscopic Variceal Ligation Followed by Argon Plasma Coagulation

The endoscopic approach is currently the preferred choice for treatment of esophageal varices, with endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL) both being widely performed. Several clinical trials have compared the combination of EVL and EIS with EVL alone or with EIS alone. Esophageal varices tend to recur more often after EVL than EIS, and therefore additional treatment is warranted with the former procedure. To prevent recurrence, it is not only essential to completely eliminate the varices but also to produce fibrosis of esophageal mucosa. Argon plasma coagulation (APC) is a noncontact coagulation method that involves the application of a high-frequency electrical arc to a jet of argon gas. APC allows shallow coagulation of an extensive area within a short period of time, making it ideal for mucosal fibrosis therapy of esophageal varices. EVL combined with APC is superior to EVL alone and is not associated with major complications. Since APC is theoretically well suited for mucosal fibrosis therapy, it can be used for complete elimination of esophageal varices and for fibrosis of the distal esophageal mucosa.