Endoscopic treatments for chronic radiation proctitis

Abstract

Chronic radiation proctitis is a complication that occurs in patients who receive radiation therapy for pelvic malignancies. The common presentation is with rectal bleeding, but also rectal pain, diarrhea, tenesmus and even passage of mucus can occur. The optimal treatment of bleeding due to radiation proctitis remains unclear. Among various therapeutic options, medical management is generally ineffective and surgical intervention has a high incidence of morbidity. Promising advances have been made in endoscopic therapy, including argon plasma coagulation (APC), formalin application as well as new techniques such as radiofrequency ablation and cryoablation. APC is a safe, highly effective and long-lasting therapy in patients with rectal bleeding associated with radiation proctitis. It has been shown that several sessions of APC reduce the rate of bleeding and therefore the blood transfusion requirements. Moreover, the effect of treatment is long lasting. However, best results are achieved in patients with mild to moderate radiation proctitis, leaving space for alternative treatments for patients with more severe disease. In patients with severe or refractory radiation proctitis intra rectal formalin application is an appropriate treatment option. Radiofrequency ablation and cryoablation have shown efficacy as alternative methods in a limited number of patients with refractory chronic radiation proctitis.

Keywords: Radiation proctitis; Endoscopic treatment; Argon plasma coagulation; Formalin application; Cryoablation; Radiofrequency ablation

Core tip: Chronic radiation proctitis presents with rectal bleeding, pain, diarrhea, tenesmus and passage of mucus. Among other therapeutic options, endoscopic therapy with argon plasma coagulation (APC) is a safe and highly effective in patients with rectal bleeding associated with radiation proctitis. Although best results are achieved in patients with mild to moderate lesions, APC therapy reduces the rate of bleeding and blood transfusion requirements and its effect last for long. In patients with severe or refractory radiation proctitis intra rectal formalin application,radiofrequency ablation and cryoablation have shown efficacy in a limited number of patients.