Sorry for this long post But here goes: Has anyone here had Argon plasma coagulation of pouch ulcers??  My 32 year old j-pouch (installed for UC and colon cancer) is  scheduled for annual pouchoscopy Thurs. 9/27 a.m. by GI.  Last scope was April 2015.  History of ulcers in ileoanal pouch; juncture of pouch and afferent limb. Anastomsis ulcer biopsy showed "granulation tissue w/acute and chronic inflammation, fibrosis, and scant amt of intact epithelium."   Lab work several months later revealed anemia and low iron for which have been taking iron and levels came up to normal and I still take the iron and levels remain normal. However, when I presented with the low levels, GI felt the anemia was likely coming from the ulceration of the particular area in question and wants to do argon plasma coagulation there to stave off the suspected source of blood loss.  Altho Colon rectal surgeon did not say anything against having it done,  he does not feel that this is the cause of the anemia as he feels I would be seeing some sort blood when I have bm's if this was the case.   He knows the GI and says she is not very aggressive and "it should be ok with a "light hand" if I decide to do it but was otherwise non committal.   At my recent meeting, with the GI when I discussed the argon once again with her  and my anxiety about it, the decision to do it or not was put off until she sees me in the scope room before the anesthesia.

I however, am extremely nervous about having this done for  a variety of reasons, foremost of which I have never heard of this being done in j-pouch ulcers (Have you??)and worry about, altho relatively rare according to my research, side affects such as stenosis, burning too much tissue, or even worse things have been mentioned. However, as said, I haven't found any cases of this being done for pouchers .   I tend to subscribe to the theory of "if it isn't broke don't fix it" and I am leading a "normal life" and don't want to risk any consequences without good reason.  Your imput please in having this done during this scope ?(or taking wait and see attitude for the next time? )I don't want to put myself I harms way by doing it or avoiding the argon. Which is the safer option?  Or am I blowing this whole thing up too much?? Thank you so much!!

hattie

Original Post

If an ulcer is actively bleeding it may be necessary to stop that bleeding. That's not what you're describing, though.  Whether your anemia is a result of bleeding from these ulcers is less important than what's causing the ulcers, and how it's being treated. If that's not addressed, then it doesn't matter whether you laser this batch, since more will form.

is this pouchitis? Cuffitis? Crohn's? There are treatments for each of these. When the treatment is effective then the ulcers will heal.

I concur with Scott. But, it is possible to have ulcers that are not responding to other treatments, and coagulation might work.

Still, you want to proceed only if it makes sense for you.

Particularly when you have conflicting expert opinions, it makes sense to step back and seriously consider your options. Is plasma coagulation dangerous for you? I doubt it, but if your surgeon is not convinced you need it, I can understand your hesitation. One thing though, occult blood loss (loss that is not visible) is a common cause of anemia. If you have been evaluated by a hematologist and HE concurs that your anemia is due to GI losses, then I would go ahead with the procedure. 

I try not to second guess my docs too much. They are the ones with the education and experience.

Jan

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