Efficacy of cryospray ablation for the treatment of chronic radiation proctitis in a pilot study.
OBJECTIVE
Radiation proctitis, a common condition associated with radiotherapy for the treatment of pelvic cancers, is characterized by difficult to manage rectal pain and bleeding. Cryotherapy is a novel technique, previously used in the treatment of vascular ectasias in the upper gastrointestinal tract. The aim of the present study was to determine the efficacy of cryospray application in the treatment of radiation proctitis.


METHODS
This is a prospective case-series pilot study. Ten patients with symptomatic chronic radiation proctitis were consecutively enrolled over a 2-year period. Baseline clinical data were collected and an endoscopic score was calculated based on the density of ectasias and circumferential involvement. Subjects underwent up to four cryospray ablation treatment sessions at approximately 4-week intervals or until resolution of the proctitis. The endpoints of the study were endoscopic and clinical improvement in radiation proctitis.


RESULTS
Ten patients (nine males and one female) with a mean age of 74 ± 7 years underwent cryospray treatment; sessions ranged from one to four (six patients had one session, three patients had two sessions, and one patient underwent four sessions). Endoscopic score significantly decreased from a mean of 10.2 ± 3.0 to 4.0 ± 2.8 (P = 0.016). Rectal pain significantly decreased from a mean of 3.1 ± 3.0 to 1.2 ± 1.7 (P = 0.042) and rectal bleeding improved in 86% (six out of seven) of patients. Nine patients reported improvement in overall well-being. No major complications were encountered.


CONCLUSIONS
Cryotherapy is an effective method in the management of chronic radiation proctitis with minimal complications.
Gastroenterology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA. fouad.moawad@med.navy.mil
Fouad J
FJ
Moawad
Corinne L
CL
Maydonovitch
J David
JD
Horwhat
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D017679:Cryotherapy / Q000379:methods*; D004108:Dilatation, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011349:Proctitis / Q000209:etiology / Q000628:therapy*; D011446:Prospective Studies; D012007:Rectum / Q000473:pathology / Q000528:radiation effects; D016896:Treatment Outcome