title: Long-term outcome of argon plasma coagulation therapy for bleeding caused by chronic radiation proctopathy.
abstract: 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.
authors.affiliation: Division of Gastroenterology and Digestive Endoscopy ASL NA5-Hospital Agostino Maresca, Torre del Greco, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Rotondano
authors.forename: M A
authors.initials: MA
authors.lastname: Bianco
authors.forename: R
authors.initials: R
authors.lastname: Marmo
authors.forename: R
authors.initials: R
authors.lastname: Piscopo
authors.forename: L
authors.initials: L
authors.lastname: Cipolletta
mesh_terms: 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
chemical_list: D006454:Hemoglobins; D001128:Argon