Healing of solitary rectal ulcers with multiple sessions of argon plasma coagulation.
BACKGROUND
Solitary rectal ulcer syndrome (SRUS) is an uncommon disorder of evacuation. Management of bleeding ulcers is usually unsatisfactory with conventional treatment. Argon plasma coagulation (APC) has been reported to control bleeding; however, it has not been shown to result in ulcer healing. The aim of the present study was to: (i) to investigate the efficacy and safety of APC in controlling bleeding from SRUS; and (ii) to study its efficacy in the healing of ulcer/s.


METHODS
Twenty-four patients with bleeding SRUS diagnosed on clinical, colonoscopic, and histological findings were randomized to receive either standard care alone (12 patients) or to undergo multiple sessions of APC in addition (12 patients). All patients were followed up to determine ulcer healing.


RESULTS
Twenty-four patients with a mean duration of symptoms of 12.6 +/- 4.8 months were included. Bleeding was controlled with one (n = 5) or two sessions (n = 7) of APC. Reduction in size and depth of ulcer was noted. Eight out of 12 patients who received APC had complete healing of ulcers after four to eight sessions, carried out 2-4 weeks apart. The remaining four patients had a reduction in size and depth of ulcers compared to their pretreatment appearance. All patients were advised to have a high intake of fluids, fiber and laxatives, and to undergo biofeedback and behavior modification therapy in addition to the treatment.


CONCLUSIONS
APC controls bleeding in patients with SRUS and it also improves the healing of these ulcers.
Somani
Sanjay Kumar
SK
Department of Gastroenterology, SPS Apollo Hospitals, Ludhiana, Punjab. sanjayksomani@rediffmail.com
Ghosh
Arindam
A
Avasthi
Gurcharan
G
Goyal
Richa
R
Gupta
Puneet
P
D000293:Adolescent; D000328:Adult; D001676:Biofeedback, Psychology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy; D006801:Humans; D017075:Laser Coagulation / Q000379:methods*; D054020:Lasers, Gas / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012002:Rectal Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014456:Ulcer / Q000150:complications / Q000473:pathology / Q000601:surgery*; D014945:Wound Healing; D055815:Young Adult