Endoscopic Therapy with Argon Plasma for Radiation Proctitis: Factors Associated to the Number of Therapeutic Sessions

Abstract

Introduction: Radiation proctitis appears as a result of radiotherapy. Argon plasma therapy (APC) is an option for its treatment. Objective: To describe the results of APC therapy on the radiation proctitis and factors associated to the number of sessions to achieve resoluteness of bleeding. Method: An observational study was performed in 38 patients who suffering from radiaton proctitis and rectorrhaegy, who received a treatment with APC untill cessation of bleeding and the improvement of their haemoglobin and later follow-up treatment, to 6 and 12 months of it, in the endoscopy Unit, from 2012 to 2015. Values of mean and percentage were calculated; different statistical tests were used to evaluate association between some variables. Results: The mean age was 62.1 (range 30-83) years, female group and cervix cancer predominated in 34 (89.5%) and 27 (71.7%) patients, with a mean of 30.5 radiation sessions (range 21-42) and a mean of 9.9 months (range 3-24) to start post-radiation bleeding, 18 (47.4%) sick had severe bleeding. The mean hemoglobin was 9.5 g/dl (5.4 to 13.8) and 12 cases (31.6%) required transfusion. Grade C of proctitis, ≤10 cm of extension and ≤50% of mucosa affected were prevailed in 18 (47.4%), 20 (52.6%) and 25 (65.8%) cases respectively; 50% of cases had friability. The mean therapeutic sessions to resolution of bleeding was 3.1 (range 1-8). Mean hemoglobin after APC therapy increased to 11.4 (p <0.05). A higher number of therapeutic sessions was associated with the highest percentage of affected circumferential mucosa (p = 0.012). Proctalgia was found in 2 (5.3%) patients. Conclusion: APC is a good therapy for radiation proctitis with resolution of bleeding and the improvement of haemoglobin using less therapeutic sessions and few complications. The highest percentage of mucosa circumferentially affected with lesions influences the need to apply a greater number of therapeutic sessions.