Long-term outcome of argon plasma coagulation therapy for bleeding caused by chronic radiation proctopathy.
BACKGROUND
Radiation-induced proctopathy is a serious complication of radiation therapy for pelvic malignancy.


OBJECTIVE
To assess the safety and efficacy of argon plasma coagulation in the treatment of haemorrhagic radiation-induced proctopathy.


METHODS
Twenty-four patients with rectal bleeding due to radiation-induced proctopathy were prospectively enrolled in the study.


METHODS
Indications for treatment were iron deficiency anaemia (n = 16) and persistent bleeding, despite pharmacotherapy (n = 8). Argon flow and power used were 0.8-1.2 l/min and 40 W, respectively. An interval of at least 4 weeks was allowed between treatment sessions. Haemoglobin level, bleeding severity score, number of admissions and transfusion requirements were recorded after endoscopic coagulation and before 12 and 24 months.


RESULTS
A median of 2.5 therapeutic sessions per patient were performed (range 1-6). All patients reported clinical improvement and/or cessation of rectal bleeding. The mean value of the bleeding severity score decreased from 2.9 to 0.8 (P < 0.01), while average haemoglobin levels increased by a mean of 1.9 mg/dl at the end of the treatments (P < 0.05). During a minimum follow-up of 24 months (range 24-60), rectal bleeding recurred in two cases and was successfully retreated endoscopically. One patient developed a recto-vaginal fistula.


CONCLUSIONS
Argon plasma coagulation appears to be a safe and effective technique for management of rectal bleeding caused by radiation-induced proctopathy.
Rotondano
G
G
Division of Gastroenterology and Digestive Endoscopy ASL NA5-Hospital Agostino Maresca, Torre del Greco, Italy.
Bianco
M A
MA
Marmo
R
R
Piscopo
R
R
Cipolletta
L
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001128:Argon / Q000627:therapeutic use; D002277:Carcinoma / Q000532:radiotherapy; D004564:Electrocoagulation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000601:surgery*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000532:radiotherapy; D011878:Radiotherapy / Q000009:adverse effects*; D012002:Rectal Diseases / Q000209:etiology* / Q000601:surgery*; D012008:Recurrence; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy; D014594:Uterine Neoplasms / Q000532:radiotherapy
D006454:Hemoglobins; D001128:Argon