|
1
|
De Sena G, Mongardini FM, Porpora D, Mauro M, Bentivoglio D, Centore D, Brusciano L, Gambardella C, Lauro A, Docimo L, Napolitano V. DDS-SIRC Cooperative Conferences Feel the Burn: RFA for Chronic Radiation Proctitis. Dig Dis Sci 2024; 69:3147-3155. [PMID: 39009917 DOI: 10.1007/s10620-024-08553-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Accepted: 06/25/2024] [Indexed: 07/17/2024]
Abstract
Chronic radiation proctitis, although relatively rare, can be the source of severe comorbidity in patients who had undergone prior radiotherapy for pelvic malignancy. Although current treatments for radiation proctitis include argon plasma coagulation, heater probe, bipolar neodymium/yttrium aluminum garnet (Nd: YAG) lasers, these interventions are often burdened by the frequent occurrence of rectal ulcerations and stenosis. Since radiofrequency ablation (RFA) is frequently used to ablate esophageal malignancy and pre-malignancy, we report the efficacy of RFA using through the scope system in two patients with rectal bleeding due to radiation proctitis. In both cases, the procedure was well-tolerated with hemostasis achieved after 1 or 2 sessions of RFA. Mucosal re-epithelialization was observed in areas of previous bleeding with no stenosis or ulceration observed at follow-up.
Collapse
Affiliation(s)
- Gabriele De Sena
- Department of Physiology and Pathophysiology, Faculty of Medicine, University of Ostrava, Ostrava Syllabova 19, Ostrava Vitkovice, 70030, Czech Republic
- Unit of Endoscopic Surgery, Department of Surgery, University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Federico Maria Mongardini
- Division of General, Oncological, Mini‑Invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", 80131, Naples, Italy.
| | - Danilo Porpora
- Unit of Endoscopic Surgery, Department of Surgery, University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Maria Mauro
- Unit of Endoscopic Surgery, Department of Surgery, University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Davide Bentivoglio
- Division of General, Oncological, Mini‑Invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Davide Centore
- Division of General, Oncological, Mini‑Invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Luigi Brusciano
- Division of General, Oncological, Mini‑Invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Claudio Gambardella
- Division of General, Oncological, Mini‑Invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Augusto Lauro
- Department of Surgery, Sapienza University, 00185, Rome, Italy
| | - Ludovico Docimo
- Division of General, Oncological, Mini‑Invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Vincenzo Napolitano
- Unit of Endoscopic Surgery, Department of Surgery, University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| |
Collapse
|
|
2
|
Polese L, Giugliano E, Cadrobbi R, Boemo DG. Diode Laser Therapy for Radiation-Induced Vascular Ectasia: Long-Term Results and Cost Analysis. Life (Basel) 2023; 13:life13041025. [PMID: 37109554 PMCID: PMC10144337 DOI: 10.3390/life13041025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/23/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Collateral damage to surrounding healthy tissues has been reported in patients who undergo radiation therapy for pelvic malignancies. This study aimed to evaluate the safety, efficacy and cost efficiency of endoscopic diode laser therapy in patients diagnosed with chronic radiation proctitis (CRP). METHODS The data of 24 patients (median age 78, range 67-90 years) who presented rectal bleeding and were diagnosed with CRP after undergoing high-dose radiotherapy for prostatic cancer and underwent diode laser therapy were evaluated retrospectively. Non-contact fibers were used in the patients who underwent the procedure without sedation in an outpatient setting. RESULTS The patients underwent a median of two sessions; overall, a mean of 1591 J of laser energy per session was used. No complications were noted during or after the procedures. Bleeding was completely resolved in 21/24 (88%) patients, and two patients showed improvement (96%). It was not necessary to suspend antiplatelet (six patients) or anticoagulant (four patients) therapy during the treatment course. The mean cost per session was EUR 473.4. CONCLUSIONS The study findings demonstrated that endoscopic non-contact diode laser treatment in CRP patients is safe, effective and cost efficient. For this procedure, antiplatelet and anticoagulant therapy suspension, intraprocedural sedation and hospital admission are not required.
Collapse
Affiliation(s)
- Lino Polese
- First Surgical Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy
| | - Emilia Giugliano
- First Surgical Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy
| | - Roberto Cadrobbi
- First Surgical Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy
| | | |
Collapse
|
|
3
|
Tang CE, Cheng KC, Wu KL, Chen HH, Lee KC. A Retrospective Single-Arm Cohort Study in a Single Center of Radiofrequency Ablation in Treatment of Chronic Radiation Proctitis. Life (Basel) 2023; 13:life13020566. [PMID: 36836925 PMCID: PMC9958826 DOI: 10.3390/life13020566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/21/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Chronic radiation proctitis (CRP) may develop in patients within months to years after undergoing pelvic radiotherapy. Numerous treatment modalities are available to achieve hemostasis in CRP, but the optimal treatment remains controversial. We report our clinical experience and long-term outcomes using radiofrequency ablation (RFA) in patients with CRP. METHODS We retrospectively reviewed patients who underwent RFA for CRP at Kaohsiung Chang Gung Memorial Hospital between October 2015 and March 2021. The patient characteristics, endoscopic findings, and clinical outcomes were collected and analyzed. RESULTS 35 total patients were enrolled in the study. The mean age was 70.5 ± 12.4 years. All patients sustained repeated rectal bleeding before RFA, and 15 of 35 patients needed blood transfusion. Bleeding cessation was achieved in all patients. Mean follow-up time was 18.6 months (ranging from 2 to 52 months). The hemoglobin (Hb) levels at 6 months after RFA revealed significant improvement from 11.0 ± 2.3 to 11.8 ± 1.9 g/dL (p = 0.048). The rectal telangiectasia density (RTD) scores also showed significant improvement from 2.96 ± 0.2 to 0.85 ± 0.7 (p < 0.0001). In conclusion, RFA treatment is safe and effective in controlling rectal bleeding in CRP without serious complications and can be considered as a first-line or alternative endoscopic treatment for patients with CRP.
Collapse
Affiliation(s)
| | | | | | | | - Ko-Chao Lee
- Correspondence: ; Tel.: +886-7-7317123; Fax: +886-7-7318762
| |
Collapse
|
|
4
|
McCarty TR, Garg R, Rustagi T. Efficacy and safety of radiofrequency ablation for treatment of chronic radiation proctitis: A systematic review and meta-analysis. J Gastroenterol Hepatol 2019; 34:1479-1485. [PMID: 31111527 DOI: 10.1111/jgh.14729] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 04/22/2019] [Accepted: 05/11/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIM Although argon plasma coagulation is the current standard endoscopic treatment for chronic radiation proctitis (CRP), radiofrequency ablation (RFA) has emerged as an attractive alternative. The aim of this study is to evaluate the efficacy and safety of RFA for the treatment of CRP. METHODS Searches of PubMed, EMBASE, Web of Science, and Cochrane Library databases were performed from 2004 through March 2018. Review and data abstraction were performed independently by two authors. Measured outcomes included hemoglobin, transfusion dependence, number of treatment sessions, RFA settings, and serious adverse events. RESULTS Six studies (n = 71; mean age 73.41 ± 1.88 years; 90.14% male) were included. Thirty-eight percent of patients failed prior treatment with argon plasma coagulation. Patients underwent a mean of 1.71 ± 0.34 RFA sessions with 24.54 ± 16.47 RFA applications per session. Pooled clinical and endoscopic success of RFA was 99% (95% confidence interval [CI]: 90-100; P < 0.001) and 100% (95% CI: 94-100; P < 0.001), respectively. Serious adverse events were reported in one patient-pooled rate of 0% (95% CI: 0-3; P < 0.001). Mean pre-procedure hemoglobin was 10.38 ± 1.82 g/dL with significant improvement observed post-RFA [weighted mean difference 2.49 g/dL (95% CI: 2.16-2.82; P < 0.001)]. Among transfusion-dependent patients, 85% (95% CI: 68-97; P < 0.001) became transfusion-free post-RFA. Pooled mean follow-up was 19.73 ± 9.72 months. CONCLUSION Despite limited long-term data on RFA for CRP, available evidence suggests RFA is an effective and safe treatment.
Collapse
Affiliation(s)
- Thomas R McCarty
- Department of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Rajat Garg
- Department of Internal Medicine, Saint John Hospital and Medical Center, Detroit, Michigan, USA
| | - Tarun Rustagi
- Division of Gastroenterology and Hepatology, University of New Mexico, Albuquerque, New Mexico, USA
| |
Collapse
|
|
5
|
Chou CK, Hsieh PH, Chen CY, Chen SH. Using radiofrequency ablation for conventional endoscopic treatment refractory bleeding from radiation proctitis: A single center cohort. ADVANCES IN DIGESTIVE MEDICINE 2018. [DOI: 10.1002/aid2.13074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Chu-Kuang Chou
- Division of Gastroenterology and Hepatology; Chia-Yi Christian Hospital; Chia-Yi Taiwan
- Department of Integrated Diagnostics and Therapeutics; National Taiwan University Hospital; Taipei Taiwan
| | - Ping-Hsin Hsieh
- Division of Gastroenterology and Hepatology; Chia-Yi Christian Hospital; Chia-Yi Taiwan
- Department of Integrated Diagnostics and Therapeutics; National Taiwan University Hospital; Taipei Taiwan
- Department of Gastroenterology; Chimei Medical Center; Tainan Taiwan
| | - Chi-Yi Chen
- Division of Gastroenterology and Hepatology; Chia-Yi Christian Hospital; Chia-Yi Taiwan
| | - Sheng-Hsuan Chen
- Division of Gastroenterology and Hepatology; Chia-Yi Christian Hospital; Chia-Yi Taiwan
- Department of Internal Medicine; Taipei Medical University; Taipei Taiwan
| |
Collapse
|
|
6
|
Polese L, Marini L, Rizzato R, Picardi E, Merigliano S. Endoscopic diode laser therapy for chronic radiation proctitis. Lasers Med Sci 2017; 33:35-39. [DOI: 10.1007/s10103-017-2323-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 09/05/2017] [Indexed: 12/20/2022]
|
|
7
|
Patel A, Patel S, Wickremesinghe PC, Vadada D. Radiofrequency ablation using Barrx ® for the endoscopic treatment of gastric antral vascular ectasia: a series of three cases and a review of the literature on treatment options. Clin Exp Gastroenterol 2017; 10:113-120. [PMID: 28744150 PMCID: PMC5513699 DOI: 10.2147/ceg.s80241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Gastric antral vascular ectasia (GAVE), also known as "watermelon stomach", is an uncommon condition, which can cause gastrointestinal bleeding due to rupture of blood vessels that line the stomach. The pathogenesis of GAVE remains unclear; however it is thought that hemodynamic changes, mechanical stress, and autoimmune factors all have a part to play. A range of conditions are also commonly associated with the syndrome, such as portal hypertensive gastropathy, liver cirrhosis, and autoimmune disorders. Less commonly, chronic renal failure, cardiac diseases, and bone marrow transplantation have coexisted with GAVE. The diagnosis is usually based on visualization of the tissue upon endoscopy; however, histology plays a role in uncertain cases. The typical "watermelon" appearance relates to the tissue having a striped appearance radiating out from the pylorus. Medical treatment has failed to show satisfactory results and surgery is usually considered as a last resort, due to its increased risk for complications and mortality. Lasers and argon plasma coagulation have been used recently, and been shown to be as effective as surgery and a safer option. We present three cases of gastric antral vascular ectasia treated at our institution with radiofrequency ablation and review the literature on treatment modalities for GAVE.
Collapse
Affiliation(s)
- Anish Patel
- Department of Gastrointestinal Medicine, Richmond University Medical Center, Staten Island, NY, USA
| | - Sunil Patel
- Department of Gastrointestinal Medicine, Richmond University Medical Center, Staten Island, NY, USA
| | | | - Deepak Vadada
- Department of Gastrointestinal Medicine, Richmond University Medical Center, Staten Island, NY, USA
| |
Collapse
|
|
8
|
Lenz L, Rohr R, Nakao F, Libera E, Ferrari A. Chronic radiation proctopathy: A practical review of endoscopic treatment. World J Gastrointest Surg 2016; 8:151-60. [PMID: 26981189 PMCID: PMC4770169 DOI: 10.4240/wjgs.v8.i2.151] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 11/20/2015] [Accepted: 12/13/2015] [Indexed: 02/06/2023] Open
Abstract
Chronic radiation proctopathy (CRP) is a troublesome complication of pelvic radiotherapy. The most common presentation is rectal bleeding. CRP symptoms interfere with daily activities and decrease quality of life. Rectal bleeding management in patients with CRP represents a conundrum for practitioners. Medical therapy is ineffective in general and surgical approach has a high morbid-mortality. Endoscopy has a role in the diagnosis, staging and treatment of this disease. Currently available endoscopic modalities are formalin, potassium titanyl phosphate laser, neodymium:yttrium-aluminum-garnet laser, argon laser, bipolar electrocoagulation (BiCAP), heater probe, band ligation, cryotherapy, radiofrequency ablation and argon plasma coagulation (APC). Among these options, APC is the most promising.
Collapse
|
|
9
|
Frazzoni L, La Marca M, Guido A, Morganti AG, Bazzoli F, Fuccio L. Pelvic radiation disease: Updates on treatment options. World J Clin Oncol 2015; 6:272-280. [PMID: 26677440 PMCID: PMC4675912 DOI: 10.5306/wjco.v6.i6.272] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/18/2015] [Accepted: 10/13/2015] [Indexed: 02/06/2023] Open
Abstract
Pelvic cancers are among the most frequently diagnosed neoplasms and radiotherapy represents one of the main treatment options. The irradiation field usually encompasses healthy intestinal tissue, especially of distal large bowel, thus inducing gastrointestinal (GI) radiation-induced toxicity. Indeed, up to half of radiation-treated patients say that their quality of life is affected by GI symptoms (e.g., rectal bleeding, diarrhoea). The constellation of GI symptoms - from transient to long-term, from mild to very severe - experienced by patients who underwent radiation treatment for a pelvic tumor have been comprised in the definition of pelvic radiation disease (PRD). A correct and evidence-based therapeutic approach of patients experiencing GI radiation-induced toxicity is mandatory. Therapeutic non-surgical strategies for PRD can be summarized in two broad categories, i.e., medical and endoscopic. Of note, most of the studies have investigated the management of radiation-induced rectal bleeding. Patients with clinically significant bleeding (i.e., causing chronic anemia) should firstly be considered for medical management (i.e., sucralfate enemas, metronidazole and hyperbaric oxygen); in case of failure, endoscopic treatment should be implemented. This latter should be considered the first choice in case of acute, transfusion requiring, bleeding. More well-performed, high quality studies should be performed, especially the role of medical treatments should be better investigated as well as the comparative studies between endoscopic and hyperbaric oxygen treatments.
Collapse
|
|
10
|
Fujii-Lau LL, Wong Kee Song LM, Levy MJ. New Technologies and Approaches to Endoscopic Control of Gastrointestinal Bleeding. Gastrointest Endosc Clin N Am 2015; 25:553-67. [PMID: 26142038 DOI: 10.1016/j.giec.2015.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Endoscopic treatment of gastrointestinal (GI) bleeding is considered the first line of therapy. Although standard techniques, such as epinephrine injection, through-the-scope hemoclips, bipolar coagulation, argon plasma coagulation, and band ligation are routinely used, some GI bleeds are refractory to these therapies. Newer technologies have emerged to assist with the treatment of GI bleeding. This article highlights endoscopic and endoscopic ultrasound-guided therapies that may be used by experienced endoscopists for the primary control of GI bleeding or for cases refractory to standard hemostatic techniques.
Collapse
Affiliation(s)
- Larissa L Fujii-Lau
- Division of Gastroenterology and Hepatology, Washington University, 660 S. Euclid Ave Campus, Box 8124, St Louis, MO 63110, USA
| | - Louis M Wong Kee Song
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Michael J Levy
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
| |
Collapse
|