Comparison between two different parameters of argon plasma coagulation in the treatment of chronic radiation proctopathy

Abstract

Dear Editor: Chronic radiation proctopathy (CRP) is the most frequent radiotherapy complication of patients with pelvic malignancies, occurring in 5-20 % of cases. CRP is characterized by endothelial dysfunction, microvascular injury with ischemia, tissue fibrosis, and telangectasias, leading frequently to rectal bleeding. Argon plasma coagulation (APC) has been the preferred modality of invasive treatment for most of these patients presenting rectal bleeding due to its accessibility, effectiveness, and low risk of complications. APC is a non-contact coagulating method that uses a high-frequency electrosurgically ionized argon gas for tissue coagulation within 0.5 to 3 mm of deepness. The APC-related complications seem to be associated to higher argon flow rates and power settings. Our previous experience in the treatment of CRP with APC at 40-50 power and 2.0-2.5 L/min was associated with high rates of complications including deep and large rectal ulcers. Based in ex vivo experiments, it has been suggested that APC treatment was optimal at a power of 40 W and a gas flow rate at a 1.2 L/ min. However, there is still no consensus on the optimal settings of electric power and argon gas flow rate. Therefore, the aim of this study was to compare the efficacy and safety of two different settings of APC in the treatment of CRP (40 W power and 1.2 L/min versus 40-50 power and 2.0-2.5 L/min).

Therapeutics in Radiation-induced Proctopathy: A Systematic Review

“…19,82 Another factor that influences the formation of ulcers and the risk of complications are the parameters: the flow and power used. 83 The use of APC is inexpensive (in comparison to other laser therapies), it is easy to apply, and effective for the treatment of patients with radiation-induced proctopathy and bleeding. [84][85][86][87] There is no additional benefit from the use of associated oral sucralfate.…”