title: Endoscopic and medical therapy for chronic radiation proctopathy:  a systematic review.
abstract: BACKGROUND
  Chronic radiation proctopathy is associated with significant morbidity. The effectiveness of endoscopic and medical therapies has not been evaluated.
  
  
  OBJECTIVE
  The aim of this study was to conduct a systematic review of the effectiveness of endoscopic and comparative medical therapies for chronic radiation proctopathy.
  
  
  METHODS
  A comprehensive search Medline and PubMed was performed.
  
  
  METHODS
  A comprehensive literature search was performed for studies of endoscopic and medical therapy for clinical and endoscopic improvement in chronic radiation proctopathy from January 1990 until December 2010. The quality of the overall evidence was rated according to the Grading of Recommendations, Assessment, Development, and Evaluation Working Group.
  
  
  METHODS
  Patients in both inpatient and outpatient settings were assessed.
  
  
  METHODS
  Patients experiencing chronic radiation proctopathy were included.
  
  
  METHODS
  Patients had undergone medical or endoscopic treatments for chronic radiation proctopathy.
  
  
  METHODS
  The primary outcomes measured were the resolution or improvement in symptoms.
  
  
  RESULTS
  A total of 39 studies were found, of which 27 evaluated endoscopic therapy and 12 evaluated medical therapy chronic radiation proctopathy. Overall, there is low-level evidence for the effectiveness of endoscopic therapy with argon plasma coagulation in reducing short-term (≤6 weeks) symptoms of chronic radiation proctopathy and insufficient evidence for long-term improvement. There is moderate-level evidence for the use of sucralfate enemas and low-level evidence for use of short-chain fatty acid enemas and hyperbaric oxygen. There is insufficient evidence for other agents: topical formalin, 5-aminosalicylic acid compounds, sulfasalazine, vitamin A, and pentoxifylline.
  
  
  CONCLUSIONS
  Individual authors were not contacted, and the search was limited to English language journals only.
  
  
  CONCLUSIONS
  Endoscopic treatment with argon plasma coagulation appears effective in the short-term outcome of chronic radiation proctopathy. There is a moderate level of evidence for the use of sucralfate enemas. Large, randomized, placebo-controlled studies evaluating endoscopic and medical therapies for chronic radiation proctopathy are needed.
authors.affiliation: Department of Medicine, VA Medical Center and University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Hanson
authors.forename: Roderick
authors.initials: R
authors.lastname: MacDonald
authors.forename: Aasma
authors.initials: A
authors.lastname: Shaukat
mesh_terms: D016099:Endoscopy, Gastrointestinal; D004733:Enema; D006801:Humans; D006931:Hyperbaric Oxygenation; D053685:Laser Therapy; D011349:Proctitis / Q000628:therapy*; D011832:Radiation Injuries / Q000628:therapy*