Rectal band ligation as a treatment for chronic radiation proctitis: a feasibility study

Abstract

Background and study aims: Chronic radiation proctitis (CRP) occurs in 5-20% of patients undergoing pelvic radiation therapy and frequently manifests with rectal bleeding. Endoscopic management of more severe and refractory cases can be challenging. Rectal band ligation (RBL) has been shown to be a feasible alternative to current available techniques, especially in extensive CRP. Our aim is to evaluate clinical and technical success of RBL. Patients and methods: We enrolled all consecutive patients treated with RBL for severe or recurrent hemorrhagic CRP. Success was defined as endoscopic evidence of complete rectal healing and/or cessation of bleeding not requiring further treatment or blood transfusion. Results: We enrolled 10 patients (7 males, mean age 75.6 years). Median length of the CRP from the anal verge was 4.5 cm and mean surface area involved was 89%. Eight patients (80%) were naïve of endoscopic treatment, while 2 underwent APC. Median follow-up was of 136.5 days. Success was achieved in 100% of patients after a mean number of 1.8 RBL sessions. A mean number of 4.7 bands were released in the first session while a mean of 3.1 and 2 bands were respectively placed in the second and third session. As for adverse events, only 1 patient reported mild tenesmus and pelvic pain after the procedure. Conclusions: RBL is a safe and effective therapeutic modality for the treatment of hemorrhagic CRP. It could be considered a valid first-line option in case of extensive rectal involvement as well as a viable rescue treatment after failed APC.

Chinese clinical practice guidelines for the prevention and treatment of radiation‐induced rectal injury

“…A recent study showed that endoscopic rectal band ligation (RBL) using a multiband ligator to ligate an affected intestinal mucosa had therapeutic effects in patients with severe or recurrent hemorrhagic colitis. Adverse reactions were mild, including mild tenesmus and pelvic pain 114 …”