Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2016; 8(2): 151-160
Published online Feb 27, 2016. doi: 10.4240/wjgs.v8.i2.151
Chronic radiation proctopathy: A practical review of endoscopic treatment
Luciano Lenz, Rachel Rohr, Frank Nakao, Ermelindo Libera, Angelo Ferrari
Luciano Lenz, Rachel Rohr, Frank Nakao, Ermelindo Libera, Fleury Medicina e Saúde, Centro de Medicina Diagnóstica, São Paulo 04513-100, Brazil
Luciano Lenz, Rachel Rohr, Frank Nakao, Ermelindo Libera, Angelo Ferrari, Endoscopy Unity, Universidade Federal de São Paulo, São Paulo 04513-100, Brazil
Angelo Ferrari, Endoscopy Unit, Hospital Israelita Albert Einstein, São Paulo 04513-100, Brazil
Author contributions: All of the authors contributed to this manuscript.
Conflict-of-interest statement: None.
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:
Correspondence to: Luciano Lenz, MD, PhD, Fleury Medicina e Saúde, Centro de Medicina Diagnóstica, Hélio Pellegrino Avenue, 720, Apto 152A, São Paulo 04513-100, Brazil.
Telephone: +55-11-32946424 Fax: +55-11-32946424
Received: June 28, 2015
Peer-review started: July 11, 2015
First decision: August 16, 2015
Revised: November 20, 2015
Accepted: December 13, 2015
Article in press: December 14, 2015
Published online: February 27, 2016

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.

Keywords: Endoscopic treatment, Radiation proctopathy, Proctitis, Argon plasma coagulation, Cryotherapy, Radiofrequency ablation, Formalin, Laser, Bipolar probe, Pelvic radiotherapy

Core tip: The objective of this review is to critically analyze the available data and our experience with this disease, with suggestions for daily practice and further research. In our view, laser treatment is an obsolete technology and can be abandoned. The bipolar probe (BiCAP) is very well indicated for patients with implantable electronic devices. The best way to use formalin is still unknown. More studies with band ligation, cryotherapy and radiofrequency ablation are still needed. Argon plasma coagulation has emerged as the front-runner, due to its ease of use, affordability, better-defined settings, effectiveness and low risk of complications.