Nd:YAG laser treatment for bleeding from radiation proctitis.
OBJECTIVE
Chronic radiation proctitis is a serious complication of radiotherapy to the pelvis. It can lead to severe blood loss, and responds poorly to surgery or local drug therapy. This study looks at which of the patients affected may benefit from endoscopic treatment with Nd:YAG laser.


METHODS
Nine patients who had previously undergone radiotherapy for pelvic malignancy a median of 14 months (range 4-43 months) before rectal bleeding started were included. Endoscopic Nd:YAG laser treatment commenced a median of four months (range 2-13 months) after the onset of blood loss, and was repeated monthly until bleeding stopped. Bleeding and transfusion requirements were documented before, during, and after a course of laser treatment.


RESULTS
Patients received an average of three laser treatments (range 1-5). Six had received transfusions prior to referral, the average requirement being 1.3 units per patient month. Only one patient required transfusion after completion of treatment, during an average follow-up of 24 months. Bleeding was reduced to occasional spotting in six cases. There were no treatment-related complications. Two of the most severely affected patients died within three months of treatment, due to recurrence of their underlying malignancy.


CONCLUSIONS
Endoscopic Nd:YAG laser treatment is safe and effective for patients with mild to moderate bleeding from radiation proctitis.
Barbatzas
C
C
National Medical Laser Centre, University College Medical School, Rayne Institute, London, United Kingdom.
Spencer
G M
GM
Thorpe
S M
SM
Sargeant
L R
LR
Bown
S G
SG
Carbatzas
C
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D009354:Neodymium; D010386:Pelvic Neoplasms / Q000532:radiotherapy; D011349:Proctitis / Q000150:complications*; D015019:Yttrium
D009354:Neodymium; D015019:Yttrium