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World J Gastroenterol. Nov 7, 2011; 17(41): 4554-4562
Published online Nov 7, 2011. doi: 10.3748/wjg.v17.i41.4554
Endoscopic management of chronic radiation proctitis
Tarun Rustagi, Hiroshi Mashimo
Tarun Rustagi, Department of Internal Medicine, University of Connecticut, Farmington, CT 06030, United States
Hiroshi Mashimo, Gastroenterology Section 111, VA Boston Healthcare System, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02130, United States
Author contributions: Rustagi T and Mashimo H contributed equally to this work and wrote the paper with final editing and approval.
Correspondence to: Hiroshi Mashimo, MD, PhD, Gastroenterology Section 111, VA Boston Healthcare System, Brigham and Women’s Hospital, Harvard Medical School, 150 South Huntington Ave., Boston, MA 02130, United States.
Telephone: +1-857-2035640 Fax: +1-857-2035666
Received: January 19, 2011
Revised: May 14, 2011
Accepted: May 21, 2011
Published online: November 7, 2011

Chronic radiation proctopathy occurs in 5%-20% of patients following pelvic radiotherapy. Although many cases resolve spontaneously, some lead to chronic symptoms including diarrhea, tenesmus, urgency and persistent rectal bleeding with iron deficiency anemia requiring blood transfusions. Treatments for chronic radiation proctitis remain unsatisfactory and the basis of evidence for various therapies is generally insufficient. There are very few controlled or prospective trials, and comparisons between therapies are limited because of different evaluation methods. Medical treatments, including formalin, topical sucralfate, 5-amino salicylic acid enemas, and short chain fatty acids have been used with limited success. Surgical management is associated with high morbidity and mortality. Endoscopic therapy using modalities such as the heater probe, neodymium:yttrium-aluminium-garnet laser, potassium titanyl phosphate laser and bipolar electrocoagulation has been reported to be of some benefit, but with frequent complications. Argon plasma coagulation is touted to be the preferred endoscopic therapy due to its efficacy and safety profile. Newer methods of endoscopic ablation such as radiofrequency ablation and cryotherapy have been recently described which may afford broader areas of treatment per application, with lower rate of complications. This review will focus on endoscopic ablation therapies, including such newer modalities, for chronic radiation proctitis.

Keywords: Chronic, Radiation proctitis, Endoscopic, Argon plasma coagulation, Radiofrequency, Cryoablation