Original article
Clinical endoscopy
Efficacy and safety of single-session argon plasma coagulation in the management of chronic radiation proctitis

https://doi.org/10.1016/j.gie.2010.01.065Get rights and content

Background

Chronic radiation proctitis (CRP) manifests as rectal bleeding 12 to 24 months after pelvic radiotherapy. No criterion standard of treatment has been established, although argon plasma coagulation (APC) has increasingly become the treatment of choice. Previous studies have applied APC over multiple sessions, necessitating increased numbers of treatments.

Objective

To assess the safety and efficacy of large-volume APC application in the treatment of CRP with the intention of a single-session treatment protocol.

Design

Prospective study.

Setting

Tertiary referral hospital.

Patients

Over an 8-year period, consecutive patients with CRP with rectal bleeding were prospectively enrolled.

Intervention

Large-volume APC application to affected rectal mucosa.

Main Outcome Measurements

Number of treatments, bleeding scores, complications.

Results

Fifty patients (mean age 72.1 years; range 51-87 years) were treated; 45 were men (prostate cancer). The mean period between radiotherapy and initial APC treatment was 23 months (range 4-140 months). Seventeen (34%) patients had grade A endoscopic severity, 23 (46%) grade B, and 10 (20%) grade C. Other therapies failed in 16 (32%) patients. The mean number of treatments was 1.36 (range 1-3) with a mean follow-up of 20.6 months (range 6-48 months). Sixty-eight percent of patients were successfully treated after 1 session and 96% after 2 sessions. Bleeding scores improved in all patients (P < .001). Seventeen (34%) patients experienced short-term, self-limiting complications; 1 (2%) patient experienced a long-term complication.

Limitations

Nonrandomized study.

Conclusions

Large-volume APC treatment was successful in the treatment of CRP, including those in whom other therapies had previously failed, and resulted in a decreased number of treatments compared with other published studies. The benefits were offset by an increased incidence of short-term complications but no increase in long-term complications.

Section snippets

Patients

The Southern Health Human Research Ethics Committee approved the study. All patients were referred for management of chronic bleeding secondary to chronic hemorrhagic radiation proctitis, were naïve to APC therapy, and were enrolled prospectively over an 8-year period between January 2001 and January 2009. Patients previously treated with modalities other than APC were included. All patients had a complete colonoscopy either before referral or at the time of first intervention to confirm the

Results

Over an 8-year period between January 2001 and January 2009, 50 consecutive patients (45 men, 5 women) were referred and treated endoscopically for CRP at a single center. The mean age was 72.1 years (range 51-87 years). Prostate cancer composed 90% of the initial malignancy requiring radiotherapy; the remaining 5 patients were all female with gynecological malignancy (2 uterine, 2 cervical, 1 vaginal). All patients underwent external beam radiotherapy; the mean duration between cessation of

Discussion

The findings of this single-center study demonstrate that APC treatment is highly effective in the treatment of patients with CRP including those in whom other therapy failed. All 50 patients with clinically apparent and debilitating rectal bleeding, with or without anemia, experienced improvement in bleeding symptoms that lasted during long-term follow-up.

One of the main aims of the study was to look at the efficacy and safety of large-volume APC application. In the current study, 68% of

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DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

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Copyright © 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.