Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2019; 25(13): 1618-1627
Published online Apr 7, 2019. doi: 10.3748/wjg.v25.i13.1618
Efficacy and complications of argon plasma coagulation for hemorrhagic chronic radiation proctitis
Qing-Hua Zhong, Zhan-Zhen Liu, Zi-Xu Yuan, Teng-Hui Ma, Xiao-Yan Huang, Huai-Ming Wang, Dai-Ci Chen, Jian-Ping Wang, Lei Wang
Qing-Hua Zhong, Zhan-Zhen Liu, Zi-Xu Yuan, Teng-Hui Ma, Xiao-Yan Huang, Huai-Ming Wang, Dai-Ci Chen, Jian-Ping Wang, Lei Wang, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Qing-Hua Zhong, Zhan-Zhen Liu, Zi-Xu Yuan, Teng-Hui Ma, Huai-Ming Wang, Jian-Ping Wang, Lei Wang, Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Xiao-Yan Huang, Dai-Ci Chen, Jian-Ping Wang, Lei Wang, Guangdong Institute of Gastroenterology, Guangzhou 510655, Guangdong Province, China
Author contributions: Zhong QH designed the study, collected and analyzed the data, and drafted the manuscript; Liu ZZ helped in collecting and analyzing the data; Yuan ZZ helped in collecting the data and drafting the manuscript; Ma TH helped in analyzing the data; Huang XY helped in collecting and analyzing the data; Wang HM helped in drafting the manuscript; Chen DC helped in designing the study and analyzing the data; Wang JP helped in designing the study and supervised the study; Wang L designed and supervised the study and revised the manuscript.
Supported by National Natural Science Foundation of China, No. 81573078; and the National Natural Science Foundation of Guangdong Province, No. 2016A030311021.
Institutional review board statement: This study was approved by the Ethics Committee of the Sixth Affiliated Hospital of Sun Yat-sen University.
Informed consent statement: Informed consent for this study was waived due to its retrospective nature. Patients agreed to undergo treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Lei Wang, MD, PhD, Chief Doctor, Professor, Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, 26 Yuancunerheng Road, Guangzhou 510655, Guangdong Province, China. wangl9@mail.sysu.edu.cn
Telephone: +86-20-38254052 Fax: +86-20-38254159
Received: January 28, 2019
Peer-review started: January 28, 2019
First decision: February 13, 2019
Revised: February 20, 2019
Accepted: February 22, 2019
Article in press: February 23, 2019
Published online: April 7, 2019
Processing time: 66 Days and 11.3 Hours
Abstract
BACKGROUND

Chronic radiation proctitis (CRP) is a complication which occurs in 1%-5% of patients who undergo radiotherapy for pelvic malignancies. Although a wide range of therapeutic modalities are available, there is no literature to date showing any particularly appropriate therapeutic modality for each disease stage. Argon plasma coagulation (APC) is currently recommended as the first-choice treatment for hemorrhagic CRP, however, its indication based on long-term follow-up is still unclear. On the hypothesis that the long-term efficacy and safety of APC are not fully understood, we reviewed APC treatment for patients with hemorrhagic CRP from a single center.

AIM

To assess the long-term efficacy and safety of APC for hemorrhagic CRP.

METHODS

This is a retrospective study of consecutive patients treated with APC for hemorrhagic CRP from January 2013 to October 2017. Demographics, clinical variables, and typical endoscopic features were recorded independently. Success was defined as either cessation of bleeding or only occasional traces of bloody stools with no further treatments for at least 12 mo after the last APC treatment. We performed univariate and multivariate analyses to identify factors associated with success and risk factors for fistulas.

RESULTS

Forty-five patients with a median follow-up period of 24 mo (range: 12-67 mo) were enrolled. Fifteen (33.3%) patients required blood transfusion before APC. Successful treatment with APC was achieved in 31 (68.9%) patients. The mean number of APC sessions was 1.3 (1-3). Multivariate analysis showed that APC failure was independently associated with telangiectasias present on more than 50% of the surface area [odds ratio (OR) = 6.53, 95% confidence interval (CI): 1.09-39.19, P = 0.04] and ulcerated area greater than 1 cm2 (OR = 8.15, 95%CI: 1.63-40.88, P = 0.01). Six (13.3%) patients had severe complications involving rectal fistulation. The only factor significantly associated with severe complications was ulcerated area greater than 1 cm2 (P = 0.035).

CONCLUSION

The long-term efficacy of APC for hemorrhagic CRP is uncertain in patients with telangiectasias present on > 50% of the surface area and ulceration > 1 cm2.

Keywords: Argon plasma coagulation; Chronic radiation proctitis; Radiation proctopathy; Efficacy; Safety

Core tip: Argon plasma coagulation (APC) is currently recommended as the first-choice treatment for hemorrhagic chronic radiation proctitis, however, its indication based on long-term follow-up is still unclear. The purpose of this study was to review APC’s long-term efficacy and safety. Forty-five patients with a median follow-up period of 24 mo were enrolled. Successful treatment was achieved in 31 (68.9%) patients. APC failure was independently associated with telangiectasias present on > 50% of the surface area and ulceration > 1 cm2. Six (13.3%) patients experienced severe complications involving rectal fistulation. The only factor significantly associated with severe complications was ulceration > 1 cm2.