Delayed Argon Plasma Coagulation After Endoscopic Injection Sclerotherapy for Esophageal Varices Reduces Recurrence Risk.

OBJECTIVES

Argon plasma coagulation (APC) is commonly used as consolidation therapy after endoscopic injection sclerotherapy (EIS) for esophageal varices (EVs); however, the optimal timing of APC remains unclear. This study evaluated the association between the EIS-APC interval and clinical outcomes.

METHODS

This single-center retrospective cohort study included consecutive patients receiving EIS followed by APC for EVs. Patients were categorized according to APC setting as inpatient or outpatient, which reflected differences in the EIS-APC interval. The primary outcome was cumulative variceal recurrence as analyzed using the Fine-Gray competing risk model. Secondary outcomes included ulcer persistence at the time of APC and procedure-related adverse events.

RESULTS

Among 112 patients, 82 underwent inpatient APC and 30 underwent outpatient APC. The median EIS-APC interval was 7 days and 28 days, respectively (p < 0.001). The cumulative 3-year incidence of variceal recurrence was lower in the outpatient group (13.9% vs. 28.0%; Gray's test, p = 0.039). In the multivariable Fine-Gray model, a longer EIS-APC interval was independently associated with a lower cumulative incidence of recurrence (subdistribution hazard ratio 0.92, 95% CI 0.86-0.99; p = 0.026). Residual post-EIS ulcers at the time of APC were also less frequent in the outpatient group (33.3% vs. 81.7%, p < 0.001), while adverse events were comparable (20.7% vs. 10.0%, p = 0.268).

CONCLUSIONS

A longer EIS-APC interval was associated with a lower recurrence rate without an increase in adverse events. Delaying APC until after mucosal healing may optimize EIS treatment outcomes.

TRIAL REGISTRATION: N/A (Only approval of the research protocol by an Institutional Review Board of Fukushima Medical University).