title: Treatment of chronic radiation proctopathy with radiofrequency ablation (with video).
abstract: BACKGROUND
  Chronic radiation proctopathy (CRP) is a common sequela occurring even many years after pelvic radiation. Current ablative therapies for bleeding ectatic vessels have the potential for deep tissue injury leading to ulcerations, perforation, and fistulas. Radiofrequency ablation (RFA) therapy avoids deep tissue injury and is a promising treatment for CRP.
  
  
  OBJECTIVE
  To assess the long-term safety and efficacy of RFA for the treatment of CRP.
  
  
  METHODS
  Multicenter, retrospective analysis of a prospectively collected database.
  
  
  METHODS
  Veterans Affairs Boston Healthcare System, Massachusetts; Sarasota Memorial Hospital and Suncoast Endoscopy of Sarasota, Florida.
  
  
  METHODS
  A total of 39 consecutive patients with CRP.
  
  
  METHODS
  Endoscopic RFA of CRP.
  
  
  METHODS
  The primary endpoint of the study was complete resolution of rectal bleeding. Secondary endpoints included visually scored improvement of CRP on endoscopic follow-up by using a rectal telangiectasia density (RTD) grading score, improvement in hemoglobin level, and adverse events related to the procedure.
  
  
  RESULTS
  A total of 39 male patients (mean [± standard deviation {SD}] age 72.9 ± 6.6 years) were included in the study. The mean number of RFA sessions was 1.49 (median 1, interquartile range [IQR] 1-2, range 1-4), with a mean interval of 18 weeks between sessions. Rectal bleeding stopped completely in all patients during the mean follow-up of 28 months (range 7-53 months). A significant improvement occurred in the mean (± SD) hemoglobin level from 11.8 ± 2 to 13.5 ± 1.6 g % (P < .0001). Endoscopic severity also improved significantly with an improvement in the median RTD score from 3 (IQR 2-3) to 0 (IQR 0-1) (P < .0001). Treatment with RFA led to discontinuation of blood transfusion and iron therapy in 92% and 82% patients, respectively.
  
  
  CONCLUSIONS
  Retrospective analysis, lack of control group.
  
  
  CONCLUSIONS
  RFA therapy led to complete resolution of rectal bleeding in all treated CRP patients, with improvement in clinical and endoscopic indices without any major adverse events. Further controlled studies are needed to establish RFA as the endoscopic therapy of choice for treatment of CRP.
authors: Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
authors: Tarun
authors: T
authors: Rustagi
authors: Florida Digestive Health Specialists, Sarasota Memorial Hospital, Sarasota, Florida, USA.
authors: F Scott
authors: FS
authors: Corbett
authors: Veterans Affairs Boston Healthcare System, Harvard Medical School, Boston, Massachusetts, USA.
authors: Hiroshi
authors: H
authors: Mashimo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation; D002908:Chronic Disease; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011349:Proctitis / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D016896:Treatment Outcome