Haemorrhagic radiation proctitis: endoscopic severity may be useful to guide therapy.
OBJECTIVE
Management of haemorrhagic radiation proctitis remains controversial. Both endoscopically delivered argon plasma coagulation and rectal administration of formalin have been recommended. We evaluated the efficacy of argon plasma coagulation according to endoscopic severity of radiation proctitis.


METHODS
Fourteen patients treated with argon plasma coagulation for rectal bleeding due to radiation proctitis were reviewed. Patients were classified with a new endoscopic score for haemorrhagic radiation proctitis, comprising three factors: telangiectasia distribution, surface area involved, and presence of fresh blood. Seven patients were categorised as having grade A (mild), four grade B (moderate), and three grade C (severe) radiation proctitis. Rectal bleeding was assessed pre- and post-treatment using a five-point bleeding scale.


RESULTS
All patients with grade A and B radiation proctitis were treated successfully by argon plasma coagulation (mean 1.5 sessions). In one patient with grade C radiation proctitis argon plasma coagulation was successful after four sessions, but in the other two patients bleeding could not be controlled; a subsequent single formalin administration was successful in both. Overall in 12 patients (85.7%) bleeding ceased or improved significantly. The mean rectal bleeding scale reduced significantly from 2.6 to 0.9. One patient treated with argon plasma coagulation developed an asymptomatic rectosigmoid stenosis.


CONCLUSIONS
Argon plasma coagulation is a simple, safe and efficacious therapy for mild/moderate radiation proctitis. In patients with severe radiation proctitis several sessions are usually necessary, and success is not certain; in these cases, topical formalin administration may be more effective. Endoscopic severity of haemorrhagic radiation proctitis may be useful to guide appropriate therapy.
Zinicola
Roberto
R
Wolfson Unit for Endoscopy, St. Mark's Hospital, Watford Road, Harrow, HA1 3UJ, UK.
Rutter
Matthew D
MD
Falasco
Giuliano
G
Brooker
Jim C
JC
Cennamo
Vincenzo
V
Contini
Sandro
S
Saunders
Brian P
BP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001128:Argon / Q000627:therapeutic use*; D005260:Female; D005404:Fixatives; D005557:Formaldehyde / Q000627:therapeutic use; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011349:Proctitis / Q000209:etiology / Q000628:therapy*; D011878:Radiotherapy / Q000009:adverse effects*; D012007:Rectum; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012812:Sigmoidoscopy; D016896:Treatment Outcome; D014565:Urogenital Neoplasms / Q000532:radiotherapy
D005404:Fixatives; D005557:Formaldehyde; D001128:Argon