Endoscopic laser coagulation of radiation-induced mucosal vascular lesions in the upper gastrointestinal tract and proximal colon.
Endoscopic laser coagulation effectively controls bleeding from radiation-induced rectal vascular lesions.


OBJECTIVE
To assess the outcome of endoscopic treatment of radiation-induced bleeding due to vascular lesions located proximal to the sigmoid colon.


METHODS
We identified 15 consecutive patients with such proximal radiation enteropathy treated at our Institution with Nd:YAG laser between 1984 and 1991. Ten patients (66%) had gastric and/or small bowel involvement, and five (33%) had colonic involvement with or without more proximal lesions. Bleeding first appeared at a mean of 21.2 +/- 12.5 months after completion of radiotherapy. Mean duration of gastrointestinal bleeding before laser treatment was 7.6 +/- 4.6 months.


RESULTS
After completion of laser therapy, bleeding ceased in nine (60%) patients, decreased in three (20%), and persisted in three (20%). The mean hemoglobin level increased from 8.4 +/- 0.5 g/dl to 10.4 +/- 0.6 g/dl after completion of laser treatments (p < 0.02). The mean number of transfusions per patient per year decreased from 10.5 +/- 2.8 to 0.9 +/- 0.7 (p < 0.01). No treatment-related complications or deaths occurred.


CONCLUSIONS
Endoscopic laser coagulation of radiation-induced mucosal vascular lesions in the upper gastrointestinal tract and proximal colon appears to be safe and, in most cases, effective.
Zighelboim
J
J
Division of Gastroenterology, Mayo Clinic Foundation, Rochester, Minnesota.
Viggiano
T R
TR
Ahlquist
D A
DA
Gostout
C J
CJ
Wang
K K
KK
Larson
M V
MV
D003108:Colonic Diseases / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D004067:Digestive System Neoplasms / Q000532:radiotherapy; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D016558:Hemostasis, Endoscopic; D006801:Humans; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000453:epidemiology / Q000601:surgery*; D013997:Time Factors