Clinical and Proctoscopic Evaluation of Topical Formalin Application in the Treatment of Chronic Radiation Proctitis

Abstract

Background and Aims:Chronic radiation proctitis is a disease associated with radiotherapy of cancer in the pelvic region. The main symptom is rectal bleeding. Several treatment modalities have been attempted, but few have demonstrated satisfactory effects. We present our experience with formalin applied locally to the rectal mucosa in the treatment of chronic radiation proctitis. Furthermore, we assess possible complications, the gravest suggested being cancer. Previous studies on the subject have reported good results, but often with a somewhat vaguely defined follow-up. Our evaluation of the treatment was based on both subjective symptoms and proctoscopic findings.Material and Methods: A small study (N = 11) was conducted retrospectively. All patients treated for chronic radiation proctitis with formalin in our clinic were identified, and data concerning effect and complications were collected by studying the patients' records, with a questionnaire and a follow-up interview and proctoscopy.Results: The study showed a marked decrease in bleeding and objective signs of proctitis in all patients. Complete cessation of bleeding was achieved in five patients. Possible complications to the treatment detected in our study were the following: anorectal pain, tenesmus, incontinence, diarrhea, and mucous rectal discharge. No signs of neoplasia were found.Conclusions: The formalin treatment had a very good effect on chronic radiation proctitis. Possible complications were detected. Except in the case of anorectal pain, these are all of a questionable nature and can possibly be attributed to chronic radiation proctitis itself rather than the formalin treatment. Further study is warranted to confirm long-term effects of the formalin and to exclude possible complications, especially secondary anorectal cancer.

Application of 4% formaldehyde under electronic colonoscope as a minimally invasive treatment of chronic hemorrhagic radiation proctitis

“…According to the literature, the concentrations of formaldehyde used were 3.6%, 4%, and 10%, and the operating methods included retention enema, use of pre-soaked gauze, and topical perfusion. [21][22][23][24][25] Haas et al [22] treated 100 patients by applying a gauze soaked with 10% formaldehyde to the rectal wound; after an average of 3.5 sessions of treatment, bleeding stopped in 93 patients, and the complication (anal pain) rate was 1.1%. Denton et al [12] analyzed the clinical data of 202 patients from 16 studies and found that the effectiveness rate ranged from 55% to 100%, and the incidence of severe complications was 7%.…”