The Effect of Hyperbaric Oxygen Therapy on Rectal Ulcers after Argon Plasma Coagulation

Abstract

Chronic radiation proctitis usually develops 3 months after therapy. Despite the lack of standard guidelines regarding treatment, argon plasma coagulation is often a safe and effective endoscopic therapy. However, rectal ulcers are a common complication after argon plasma coagulation. Nevertheless, most patients are asymptomatic and do not require additional monitoring or treatment. We report a case of an argon plasma coagulation-induced ulcer with relevant symptoms and refractory to medical treatment. The patient was treated with hyperbaric oxygen therapy and had complete resolution of the rectal ulcer. Hyperbaric oxygen therapy has shown efficacy in severe chronic proctitis and radiation-induced rectal ulcers, but no clinical report has ever been published on using hyperbaric oxygen therapy for ulcers after argon plasma coagulation. In this case, hyperbaric oxygen therapy was an effective alternative option and can be considered in patients with refractory argon plasma coagulation-induced rectal ulcers.

Comment on “The Effect of Hyperbaric Oxygen Therapy on Rectal Ulcers after Argon Plasma Coagulation”

“…The lack of guidelines for the optimal APC settings (method of application, time between sessions, and flow rate) may lead to a higher number of APC-induced ulcers. According to Sato et al [5] prevention of damage of the deeper underlying muscle layer, while maintaining an effective submucosal telangiectasia treatment, occurs with the lowest effective dose of 40 W with 1.2 L/min of gas flow and a coagulation time of 2 s. In both our case and that of Laranjo et al [1], the dose and flow applied were adequate, but the time of coagulation was not taken into consideration. The latter may have been the culprit for the development of the APC-induced ulcers.…”

“…We read with great interest the paper by Laranjo et al [1] entitled "The Effect of Hyperbaric Oxygen Therapy on Rectal Ulcers after Argon Plasma Coagulation." The authors reported the case of a patient with chronic radiation proctitis, who developed rectal ulcers after endoscopic treatment with argon plasma coagulation (APC) and was successfully treated with hyperbaric oxygen therapy (HBO).…”

“…We read with great interest the paper by Laranjo et al [1] entitled “The Effect of Hyperbaric Oxygen Therapy on Rectal Ulcers after Argon Plasma Coagulation.” The authors reported the case of a patient with chronic radiation proctitis, who developed rectal ulcers after endoscopic treatment with argon plasma coagulation (APC) and was successfully treated with hyperbaric oxygen therapy (HBO). Although it is well established that HBO therapy is an effective alternative treatment for patients with radiation-induced rectal ulcers and severe chronic proctitis [2, 3], its application has not been described as a treatment option in APC-induced rectal ulcers.…”

“…This high percentage may be caused by the frailty and poor healing of the mucosa due to thermal injury, among other factors [4]. Furthermore, Laranjo et al [1] focus on an important aspect of the APC technique itself. The lack of guidelines for the optimal APC settings (method of application, time between sessions, and flow rate) may lead to a higher number of APC-induced ulcers.…”

The effectiveness of hyperbaric oxygen therapy for managing radiation-induced proctitis – results of a 10-year retrospective cohort study

“…Among pharmacological regimens, formalin application (4-10%) has been demonstrated to be an effective medical treatment ( 8 , 23 , 25 – 28 ), as well as sucralfate enemas ( 6 , 23 , 29 ), and metronidazole combined with ciprofloxacin ( 20 , 29 ). Argon plasma coagulation (APC) is the first-line endoscopic strategy for individuals with hemorrhagic RIP ( 24 , 29 – 31 ). Surgery is generally reserved for advanced stages of RIP refractory to optimal medical and endoscopic therapies ( 8 , 30 ).…”