Endoscopic and non-endoscopic approaches for the management of radiation-induced rectal bleeding

Table 5 Surgical therapy for radiation proctitis

	Proposed mechanism	Indications
Diverting ostomy	Diversion of fecal stream allows for healing	Single institution studies support treatment of chronic radiation proctitis if refractory to medical and endoscopic measures, moderate morbidity and mortality associated
Local excision/flap reconstruction	Removal of poorly vascularized tissue and replacement with well perfused tissue	Little data exists to support the routine use of excision and reconstruction for patients with radiation proctitis
Proctectomy/exenteration	Removal of damaged tissue	Single institution studies support treatment of chronic radiation proctitis if refractory to medical and endoscopic measures, significant morbidity and mortality associated