Background and study aims: The optimal treatment of bleeding due to radiation proctitis is still controversial. Although argon plasma coagulation (APC) has been recently reported as an effective treatment, its efficacy in relation to disease severity is unknown. The study aims were to prospectively evaluate (i) the efficacy of APC in endoscopically mild and severe radiation proctitis, and (ii) the recurrence rate following successful treatment.
Patients and methods: 56 patients (mean age 68.4 years) with radiation proctitis after radiotherapy for prostate cancer were studied. All presented with rectal bleeding, occurring a median 21.5 months after radiotherapy. Using an established scoring system, patients were classified into two groups, with mild or severe disease. We also examined the correlation between endoscopic severity and hemoglobin level as a more objective measure of bleeding activity. Success was defined either as cessation of bleeding or a significant reduction so that further treatment was not required.
Results: Proctitis was classified as mild in 27 patients (48 %) and severe in 29 (52 %). Endoscopically judged severity and hemoglobin level showed good correlation (r = 0.58). All patients with mild proctitis and 23/29 (79 %) with severe disease were successfully treated (P < 0.05). During a follow-up of a mean of 17.9 months (range 6 – 33), 34/38 patients (89.5 %) remained in clinical remission. Recurrence was higher in those using anticoagulant or aspirin (P = 0.02).
Conclusions: APC is highly effective in all patients with mild radiation proctitis and in the majority of those with severe disease, providing long-lasting clinical remission.
References
1
Dearnaley D, Khoo V, Norman A. et al .
Comparison of radiation side-effects of conformal and conventional radiotherapy in prostate cancer: a randomised trial.
Lancet.
1999;
353
267-272
4
Kochhar R, Sriram P V, Sharma S C. et al .
Natural history of late radiation proctosigmoiditis treated with topical sucralfate suspension.
Dig Dis Sci.
1999;
44
973-978
6
Talley N A, Chen F, King D. et al .
Short-chain fatty acids in the treatment of radiation proctitis: a randomized, double-blind, placebo-controlled, cross-over pilot trial.
Dig Colon Rectum.
1997;
40
1046-1050
7
Pinto A, Fidalgo P, Cravo M. et al .
Short-chain fatty acids are effective in short term treatment of chronic radiation proctitis. Randomised double blind, controlled trial.
Dis Colon Rectum.
1999;
42
788-796
8
Zinicola R, Rutter M D, Falaso G. et al .
Haemorrhagic radiation proctitis: endoscopic severity may be useful to guide therapy.
Int J Colorectal Dis.
2003;
18
439-444
10
Silva R A, Correia A J, Dias L M. et al .
Argon plasma coagulation therapy for hemorrhagic radiation proctosigmoiditis.
Gastrointest Endosc.
1999;
50
221-224
12
Villavicencio R T, Rex D K, Rahmani E.
Efficacy and complications of argon plasma coagulation for hematochezia related to radiation proctopathy.
Gastrointest Endosc.
2002;
55
70-74
15
de Parades V, Etienney I, Bauer P. et al .
Formalin application in the treatment of chronic radiation-induced hemorrhagic proctitis – an effective but not risk-free procedure: a prospective study of 33 patients.
Dis Colon Rectum.
2005;
48
1535-1541
18 Farin G, Grund K H. Principles of electrosurgery, laser, and argon plasma coagulation with particular regard to colonoscopy. In: Waye JD, Rex DK, Williams CB, eds. Colonoscopy principles and practice. Malden, Massachusetts; Blackwell Publishing 2003: 393-409
19
Ladas S D, Karamanolis G, Ben-Soussan E.
Colonic gas explosion during therapeutic colonoscopy with electrocautery.
World J Gastroenterol.
2007;
13
5295-5298
