Novel and Effective Almagate Enema for Hemorrhagic Chronic Radiation Proctitis and Risk Factors for Fistula Development

Abstract

Radiation proctitis is a common complication after radiotherapy for pelvic malignant tumors. This study was conducted to assess the efficacy of novel almagate enemas in hemorrhagic chronic radiation proctitis (CRP) and evaluate risk factors related to rectal deep ulcer or fistula secondary to CRP. All patients underwent a colonoscopy to confirm the diagnosis of CRP and symptoms were graded. Typical endoscopic and pathological images, risk factors, and quality of life were also recorded. A total of 59 patients were enrolled. Gynecological cancers composed 93.1% of the primary malignancies. Complete or obvious reduction of bleeding was observed in 90% (53/59) patients after almagate enema. The mean score of bleeding improved from 2.17 to 0.83 (P<0.001) after the enemas. The mean response time was 12 days. No adverse effects were found. Moreover, long-term successful rate in controlling bleeding was 69% and the quality of life was dramatically improved (P=0.001). The efficacy was equivalent to rectal sucralfate, but the almagate with its antacid properties acted more rapidly than sucralfate. Furthermore, we firstly found that moderate to severe anemia was the risk factor of CRP patients who developed rectal deep ulcer or fistulas (P= 0.015). We also found abnormal hyaline-like thick wall vessels, which revealed endarteritis obliterans and the fibrosis underlying this disease. These findings indicate that almagate enema is a novel effective, rapid and well-tolerated method for hemorrhagic CRP. Moderate to severe anemia is a risk factor for deep ulceration or fistula.

Platelet-derived growth factor C signaling is a potential therapeutic target for radiation proctopathy

“…An increasing number of patients worldwide are affected by irradiation, and studies have shown the effects of targeting growth factors, such as palifermin (keratinocyte growth factor) and bevacizumab (vascular endothelial growth factor inhibitor), on radiation injury (33,34). Advanced therapies, including high fiber diet, topical butyrate irrigation, almagate enema, and topical formalin irrigation, have been studied in recent years (35)(36)(37)(38). However, the curative efficacy of RP is still limited, and the unmet need for RP-specific drugs is huge.…”

Risk Prediction and Treatment of Hemorrhagic Chronic Radiation Intestinal Injury Patients With LE-DVT

“…According to the experience of our research team, an ascending ladder therapy was adopted as follows. For mild to moderate hemorrhagic CRP, a novel mixture enema (almagate combined with thrombin, epidermal growth factor,metronidazole and hexadecadrol or budesonide) was an effective strategy, with 90% and 69% short-term and long-term effective rates, respectively [39]. For moderate hemorrhagic CRP, argon plasma coagulation is a well-tolerated and effective treatment option [40,41].…”