Chronic radiation proctitis – does argon plasma coagulation (APC) resolve this therapeutic problem?

Česká verzia

Authors: J. Záň ¹; I. Katuščák ²; I. Minčík ¹; D. Bestvina ¹
Authors place of work: Interná klinika – gastroenterologické pracovisko, ÚVN SNP – FN Ružomberok ¹; Martinské centrum gastroenterológie, Martin ²
Published in the journal: Gastroent Hepatol 2011; 65(6): 316-324
Category: Clinical and Experimental Gastroenterology: Original Article

Summary

Chronic radiation proctitis (ChRP) is a serious complication of pelvic radiotherapy. Its leading symptom is rectal bleeding which can be difficult to control. Medicamentous therapy has controversial or very short effect, endoscopic therapy is either very expensive (laser) or it has very frequent and substantial complication (formalin).

Aim of study:
In this prospective study we have evaluated the efficiency of argon plasma coagulation in treatment of chronic radiation proctitis as well as safety of this method and longterm outcomes.

Material and methods:
Thirty one consecutive patients with chronic radiation proctitis were treated with argon plasma coagulation with standart protocol from September 2002 to July 2007. They didn´t undergo other types of endoscopic therapy in the past. We monitored each patient’s hemorrhage intensity, hemoglobin level, number of defecations, tenesmus and rectum pain intensity before, during and after the treatment by means of evaluation scores. After treatment control endoscopy was performed.

Results:
75 therapeutic APC session were performed (mean 2,4 per patient). Rectal bleeding severity score was reduced from 3,29 to 0,10 (p < 0,001). In correlation with the treatment ChRP mean hemoglobin level was rising from 118 g/l to 134 g/l (p < 0,001). Also other symptoms of CRP were decreased by APC. There was no hemorrhage recurrence during the median follow-up of 17 months (1–42 months). None of patients experienced any significant side effect or complication during the treatment and endoscopic monitoring.

Conclusion:
Argon plasma coagulation is an efective and safe treatment for pacients with chronic radiation proctitis.

Key words:
chronic radiation proctitis – rectal bleeding – therapeutic endoscopy – argon plasma coagulation

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