Formaldehyde application for haemorrhagic radiation‐induced proctitis: a clinical and histological study

Chautems, Roland; Delgadillo, Xavier; Rubbia‐Brandt, Laura; Deleaval, Jeff Patrick; Marti, M.-C.; Roche, Bruno

doi:10.1046/j.1463-1318.2003.00396.x

Cited by 44 publications

(54 citation statements)

References 18 publications

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“…Furthermore, no systemic side effects were detected during subsequent follow-up as described by other authors. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] On the other hand, local morbidity of formalin application was not negligible in our experience. More important, painful anorectal ulceration (12 percent), anorectal stricture (18 percent), and anal incontinence (more than 18 percent) occurred.…”

Section: Discussionmentioning

confidence: 72%

“…Nor is the problem of strictures a major one because most of the patients are asymptomatic (67 percent in our study) and because dilation is rarely necessary. 12,14,20,26 Incontinence may admittedly be infrequent and minor 14,15 but, in more severe cases, it gives cause for concern because this distressing functional disturbance may significantly alter long-term quality of life. 1,2 The mechanism of local complications after formalin application is hypothetical.…”

Section: Discussionmentioning

confidence: 99%

“…11 The technique involves direct application of formalin to the rectum, either by direct instillation 11 or with formalin-soaked gauze. 12 The success of the technique with complete cessation of bleeding ranges between 60 and 100 percent, either by direct instillation of formalin [13][14][15][16][17] or with formalin-soaked gauze 12,[18][19][20][21][22][23][24][25][26][27] (Table 1). We have been favorably impressed with the initial good results of Seow-Choen et al 12 We therefore prospectively studied a large group of patients.…”

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confidence: 99%

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Formalin Application in the Treatment of Chronic Radiation-Induced Hemorrhagic Proctitis—An Effective But Not Risk-Free Procedure: A Prospective Study of 33 Patients

Parades

Etienney

Bauër

et al. 2005

Diseases of the Colon &Amp; Rectum

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Formalin application is an effective treatment for chronic radiation-induced hemorrhagic proctitis. However, local morbidity is not negligible. This result may be related to the high proportion of anal cancers in the series. In our opinion, therefore, formalin application should be reserved for severe hemorrhagic proctitis refractory to medical treatment and should be thoroughly discussed in cases of anorectal radiation-induced stricture, prior anal incontinence, or treated anal cancer.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Formalin Application in the Treatment of Chronic Radiation-Induced Hemorrhagic Proctitis—An Effective But Not Risk-Free Procedure: A Prospective Study of 33 Patients

Parades

Etienney

Bauër

et al. 2005

Diseases of the Colon &Amp; Rectum

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“…Local application of 4% formaldehyde has been used with greater therapeutic success in some studies (Table 2). 12,[39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] Evidence suggests that formalin is very effective in the treatment of CHRP, mainly in patients in whom the distal third of the rectum is affected. Other advantages of formalin application are low cost, low incidence of side-effects, ready availability, and easy application.…”

Section: Formalinmentioning

confidence: 99%

Management of chronic hemorrhagic radiation proctitis

Agrawal

Bansal

Bahadur

et al. 2007

Asia-Pac J Clncl Oncology

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Rectal bleeding secondary to radiation proctitis is the most dreaded complication of pelvic radiotherapy. Its management remains a perplexing problem despite the availability of multiple treatment modalities. Patients are usually managed on a "hit and miss" basis at most centers. Steroid, 5-aminosalicylic acid, short chain fatty acids and sucralfate enemas, hyperbaric oxygen therapy, and topical application of 4% formaldehyde all have been used with varying results. Surgical procedures such diversion colostomy or resection of involved segment have been proposed for refractory bleeding. Endoscopic methods are being increasingly adopted in the form of bipolar electrocoagulation, heat probe coagulation, photoablation, Nd:YAG laser and preferably argon plasma coagulation. The utility of conservative approaches remains far below desirable levels. Onset of hemorrhagic recurrence represents a major obstacle that leads to a need for repeated therapeutic sessions and sometimes invocation of radical techniques. This review discusses various treatment modalities and aims to identify their efficacy and limitations. A critical review was conducted of published reports regarding management of chronic hemorrhagic radiation proctitis (CHRP). Although there are few prospective randomized trials, enough evidence is available to conclude that argon plasma coagulation represents the current treatment of choice.

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“…Endoscopic treatments are numerous and are generally effective in treating the bleeding. Unfortunately, most are associated with a risk of damaging the rectal wall (1,2,4,6,7,13,(15)(16)(17)(18). The best endoscopic treatment seems to be argon plasma coagulation, both with respect to achieving effect and minimizing complications.…”

Section: Introductionmentioning

confidence: 99%

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

2013

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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.

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Formaldehyde application for haemorrhagic radiation‐induced proctitis: a clinical and histological study

Abstract: Local application of 4% formaldehyde for the treatment of haemorrhagic radiation-induced proctitis gives good results, is well tolerated and easy to perform. Formaldehyde applied selectively causes thromboses of the bleeding vessels, without deep lesions or extended necrosis.

Cited by 44 publications

References 18 publications

Formalin Application in the Treatment of Chronic Radiation-Induced Hemorrhagic Proctitis—An Effective But Not Risk-Free Procedure: A Prospective Study of 33 Patients

Formalin Application in the Treatment of Chronic Radiation-Induced Hemorrhagic Proctitis—An Effective But Not Risk-Free Procedure: A Prospective Study of 33 Patients

Management of chronic hemorrhagic radiation proctitis

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

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