Efficacy and safety of argon plasma coagulation for the treatment of hemorrhagic radiation proctitis

Abstract

Objective: to evaluate the efficacy, safety and medium-/longterm clinical course of patients undergoing endoscopic treatment with argon plasma coagulation for hemorrhagic radiation proctopathy.Design: descriptive, retrospective study with medium-and long-term follow-up.Patients, material and methods: ten patients were treated with argon plasma coagulation for hemorrhagic radiation proctopathy between July 1998 and February 2003. Inclusion criteria were: evidence of chronic rectal bleeding, consistent endoscopic findings, and absence of any other cause of hematochezia after a comprehensive ano-rectal examination and complete colonoscopy. The equipment used was a standard colonoscope, an argon delivery unit, an argon plasma coagulation probe 1.5 mm in internal diameter, and a high-frequency electrosurgical generator. Consecutive treatment sessions were programmed whenever it was considered necessary until all mucosal lesions had been treated. Clinical and evolutive follow-up was performed with a focus on tolerance, efficacy, and potential argon plasma coagulation-related complications. Data were updated by personal or telephonic interview.Results: in all patients, chronic rectal bleeding stopped after the last treatment session. The mean number of treatment sessions to stop symptoms was 1.7. Mean follow-up was 31.1 months. All sessions were well tolerated, similarly to standard rectoscopy. In one case a recurrence of rectal bleeding was observed four months later, which required two repeat sessions. Four patients were anemic at inclusion. Three of them reported a resolved anemia at the end of the study. No delayed argon plasma coagulation-related complications such us ulcers or strictures were seen.Conclusions: argon plasma coagulation appears to be a useful, effective and safe treatment for rectal bleeding resulting from chronic radiation proctitis when compared to standard medical and endoscopic treatments. These successful outcomes seem to persist even after long-term follow-up.

Efficacy and safety of single-session argon plasma coagulation in the management of chronic radiation proctitis

“…Women may present with CRP after radiotherapy for local control of gynecological cancers (cervical, ovarian); however, in most Western populations, they constitute a small minority. 6 Unlike our study, others have enrolled a higher proportion of female patients, 1,7,12,13 and therefore caution should be exercised in the interpretation and comparison of these studies because the technique and dose of radiotherapy differ significantly among different malignancies. Consequently, differences in demographics may contribute to the overall efficacy and complications of all treatments, including APC therapy, for radiation proctitis.…”

Radiation Proctitis: Current Strategies in Management

“…Single sessions have been reported to significantly improve symptoms [62], but on average, two to three treatments are needed to achieve this result. Improvements persisted for a number of months after therapy was finished [2, 63]. Most of the complications reported were mild and included cramps, mucus discharge, and stricture [2].…”

Comparative study of bipolar eletrocoagulation versus argon plasma coagulation for rectal bleeding due to chronic radiation coloproctopathy

“…The most appropriate treatment is still not clear, especially in the absence of a scoring system [3,6]. Nonsurgical management is preferable to surgery, as the latter is associated with high morbidity and mortality and should be reserved for intractable cases [1,2,4,8,9]. Reports on medical therapy have demonstrated that corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), sucralfate or short-chain fatty acid enemas tend not to be beneficial [1,6,8].…”

“…with considerable reported side effects [3,4]. In the light of these findings, endoscopic treatment is emerging as an important tool for CRCP management [1,4]. Multiple modalities are available and include Nd:YAG laser, heater probe, bipolar eletrocoagulation (BEC) and argon plasma coagulation (APC) [3,10,11].…”