Chronic radiation
proctitis complicating pelvic
radiotherapy can be debilitating. It commonly presents with rectal
bleeding, which can be difficult to control. Medical management of hemorrhagic radiation
proctitis is not very successful, although surgery carries high risks. Thus, endoscopic treatments are preferred. The aim of this study is to assess the efficacy of
argon plasma coagulation applied endoscopically to treat hemorrhagic radiation
proctitis that has been refractory to topical
formalin therapy.
METHODS: RESULTS: At a median follow-up of 11 months, ten patients (83 percent) had a significant reduction in the severity and frequency of
bleeding, with complete cessation in six (50 percent). The presence of coexistent radiation-induced sigmoiditis in two patients was associated with reduced but persistent
bleeding, because of difficulty in targeting the
bleeding sites in the sigmoid colon. The median number of treatment sessions per patient was two (range, 1-3), with the number of sessions correlated with the extent of the
proctitis. All patients had an improvement in their
hemoglobin level, with the mean increasing from 11.2 to 12.3 g/dl. In the six months before starting
therapy, all patients had been taking
iron supplements, and four had required
blood transfusions (median 3 units, range, 2-6).
Iron supplements were ceased four weeks after the completion of
therapy in all cases, and no further transfusions were required during the study period. None of the patients experienced any significant side effects or complications.
CONCLUSIONS: