title: Argon plasma coagulation in the treatment of hemorrhagic radiation proctitis is efficient but requires a perfect colonic cleansing to be safe.
abstract: OBJECTIVE
  We evaluate prospectively effectiveness, tolerance, predictive factors of failure and complications of argon plasma coagulation (APC) in the treatment of hemorrhagic radiation proctitis (HRP).
  
  
  METHODS
  Twenty-seven patients were treated by APC for HRP. Eight patients needed blood transfusion before APC. Six patients were anti-coagulated and one had severe thrombocytopenia. APC was performed without sedation in 25/27 patients. Before APC treatment, bowel preparation was performed by enema (n = 19 sessions), polyethylene glycol or sodium phosphate (n = 53 sessions). APC treatment was performed every 5 weeks. Effectiveness of APC was based on clinical and endoscopic score and biological status before and after APC treatment.
  
  
  RESULTS
  The mean follow-up was 13.6 months (range, 3-31 months). After one to seven sessions of APC (average, 2.66 sessions), twenty-five patients (92%) had no recurrence of bleeding. The bleeding score decreased from 3.03 to 0.42 (P < 0.001) and the endoscopic score from 3.08 to 0.73 (P < 0.001). Out of the eight patients requiring blood transfusion prior to APC sessions, only one required blood transfusion after APC (P < 0.05). One late relapse was observed and successfully re-treated by APC. Side effects were anal or rectal pain (n = 3) and vagal symptoms (n = 2). Three colonic explosions occurred, with perforation leading to surgery in one case. The incidence of bowel explosion was higher after local preparation (3/19 sessions) compared with oral preparation (0/53 sessions) (P < 0.05). No stricture due to APC appeared, even if telangiectasias coagulated during a session were circumferential.
  
  
  CONCLUSIONS
  Coagulation by APC is an effective and safe treatment of HRP if a complete cleansing preparation is performed to avoid explosion.
authors.affiliation: Department of Gastroenterology, Rouen University Hospital Charles Nicolle, Rouen, France. Emmanuel.Ben-soussan@chu-rouen.fr
authors.forename: E
authors.initials: E
authors.lastname: Ben-Soussan
authors.forename: M
authors.initials: M
authors.lastname: Antonietti
authors.forename: G
authors.initials: G
authors.lastname: Savoye
authors.forename: S
authors.initials: S
authors.lastname: Herve
authors.forename: P
authors.initials: P
authors.lastname: Ducrotté
authors.forename: E
authors.initials: E
authors.lastname: Lerebours
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D001128:Argon; D001803:Blood Transfusion; D002400:Cathartics / Q000008:administration & dosage; D003106:Colon / Q000528:radiation effects; D004564:Electrocoagulation / Q000009:adverse effects / Q000379:methods*; D004733:Enema / Q000379:methods; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010710:Phosphates / Q000008:administration & dosage; D011092:Polyethylene Glycols / Q000008:administration & dosage; D011349:Proctitis / Q000209:etiology / Q000601:surgery*; D011446:Prospective Studies; D011832:Radiation Injuries / Q000150:complications / Q000601:surgery*; D012002:Rectal Diseases / Q000601:surgery; D012997:Solvents / Q000008:administration & dosage
chemical_list: D002400:Cathartics; D010710:Phosphates; D012997:Solvents; D011092:Polyethylene Glycols; D001128:Argon; C018279:sodium phosphate