Efficacy and Safety of Argon Plasma Coagulation for Hemorrhagic Chronic Radiation Proctopathy: A Systematic Review

Peng, Yanan; Wang, Haizhou; Feng, Jianhua; Fang, Shilin; Zhang, Meng; Wu, Fan; Chang, Ying; Shi, Xiaohong; Zhao, Qiu; Liu, Jing

doi:10.1155/2018/3087603

Cited by 16 publications

(15 citation statements)

References 48 publications

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“…Several treatment modalities, including APC, are strongly recommended by the American Society of Colon and Rectal Surgeons (ASCRS); however, none of them are based on high-quality evidence[17]. APC has been widely reported as an effective and safe modality for the treatment of hemorrhagic CRP; however, reported effectivity and complication rates vary across studies, with effectivity rates from 50% to 100% and complication rates from 0% to 63.6%[21]. Few studies have investigated the prognostic factors and risk factors of APC for the treatment of hemorrhagic CRP.…”

Section: Discussionmentioning

confidence: 99%

“…There is no consensus on the optimal APC settings for hemorrhagic CRP. A recent systematic review summarized different APC settings in 32 trials, with the electric power ranging from 25 W to 80 W (median 50 W), and the argon flow ranging from 0.6 L/min to 3.0 L/min (median 1.5 L/min)[21]. In one study, the optimal APC settings were determined by using a swine rectum at an argon flow of 1.2 L/min and a power of 40 W with application to the lesions in 2-s pulse.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, four studies using a current of 60 W and an argon flow of > 1.5 L/min reported complications rates of 0%, 0%, 13.3%, and 35.7%. Peng et al[21] noted that APC settings seemed to have no correlation with complication rates. In our study, an argon flow of 1.0-3.0 L/min at a power of 40-60 W with application to the lesions in 1-2 -s pulses was determined by the endoscopist, while an argon flow of 1.8 L/min at a power of 50 W was routinely adopted.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and complications of argon plasma coagulation for hemorrhagic chronic radiation proctitis

Zhong

Liu

Yuan

et al. 2019

WJG

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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 cm 2 (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 cm 2 ( 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 cm 2 .

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Efficacy and complications of argon plasma coagulation for hemorrhagic chronic radiation proctitis

Zhong

Liu

Yuan

et al. 2019

WJG

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“…For mild to moderate hemorrhagic CRP, a novel mixture enema (almagate combined with thrombin, epidermal growth factor,metronidazole and hexadecadrol or budesonide) was an effective strategy, with 90% and 69% short-term and long-term effective rates, respectively [39]. For moderate hemorrhagic CRP, argon plasma coagulation is a well-tolerated and effective treatment option [40,41]. For moderate to severe hemorrhagic CRP without massive ulcers which is refractory to medical management, modi ed formalin irrigation is an effective and safe method, with an effectiveness rate of 79.1% [42].…”

Section: Discussionmentioning

confidence: 99%

Risk Prediction and Treatment of Hemorrhagic Chronic Radiation Intestinal Injury Patients With LE-DVT

Huang¹,

Kuang²,

Yuan³

et al. 2020

Preprint

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Background: After pelvic malignancy radiation, chronic radiation intestinal injury (CRII) is an unavoidable complication, and bleeding is one of the most common symptoms of CRII. Lower extremity deep venous thrombosis (LE-DVT) is another severe complication.Once hemorrhagic CRII patients suffer from LE-DVT, hemostasis and anticoagulation therapy will be adopted simultaneously, which is a therapeutic paradox, extremely intractable and serious. This study was aimed to investigate prevalence and risk factors for LE-DVT in CRII patients, and explore treatment for hemorrhagic CRII patients with LE-DVTMethods: This is a retrospective study,a total of 608 CRII hospitalized patients from November 2011 to October 2018 after pelvic malignancy radiation in our hospital were included.Univariate and multivariate analysis were conducted to investigate the associated risk factors for LE-DVT in CRII patients. Receiver operating characteristic (ROC) curve analysis was performed to investigate the independent risk factors and determine their clinically valid cut-off points. Furthermore, treatment of hemorrhagic CRII patients with LE-DVT was explored.Results: Of the 608 included CRE patients, there were 94 (15.5%) CRII patients with suspicious symptoms of LE-DVT in the lower limbs, and 32 (5.3%) patients were diagnosed with LE-DVT. Among the CRII patients with LE-DVT, 65.6% (21/32) patients were with bleeding simultaneously, 29 (90.6%) patients were anemic, with 17 (53.1%) patients having moderate anemia and 7 (21.9%) having severe anemia. Multivariate analysis showed recent surgical history (≤6 Months) (OR=0.480, 95% CI: 1.430~9.377, p=0.007) and hemoglobin (Hb) (OR=0.965, 95% CI: 0.945~0.986, p=0.001) significantly associated with development of LE-DVT. ROC curve analysis showed optimal cut-off values of Hb were 82.5 g/L (AUC=0.756, 95% CI: 0.688~0.824, sensitivity=71.9%, specificity=75.5%). After colostomy, obvious bleeding remission was found in 84.6% of hemorrhagic CRII patients with LE-DVT rapidly. And LE-DVT of the patients was obvious improved or disappeared following anticoagulation therapy or with vena cava filter or stent placement.Conclusions: Prevalence of LE-DVT in hospitalized CRII patients was 5.3%. Recent surgical history and lower Hb were independently associated with LE-DVT developing in CRII patients. And colostomy could be a good choice for intractable hemorrhagic CRII patients with LE-DVT.

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“…In our country, patients usually receive five courses of single-agent weekly cisplatin (40 mg/m2) concurrently [ 16 ]. The severe complication is uncommon in the endoscopic mucosal cauterization such as Argon plasma coagulation, and the incidence of perforation was reported to be about 3% [ 17 ]. Although the endoscopic mucosal cauterization could be associated with a fistula between the vagina and bladder, we think that the fistula happened due to the overdose to the bladder because the cystoscope showed the ulcer in the bladder.…”

Section: Discussionmentioning

confidence: 99%

Vaginal Fistulas of the Bladder and Small Bowel After Two-Dimensional Intracavitary Brachytherapy in a Patient With Cervical Cancer

Yamada

Tomita

Kitagawa

et al. 2020

Cureus

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Image-guided brachytherapy (IGBT) is commonly used for patients with cervical cancer, but two-dimensional intracavitary brachytherapy (2D-ICBT) is also still utilized for certain patients. We report a patient with cervical cancer who developed vaginal fistulas of the bladder and small bowel after chemoradiotherapy with 2D-ICBT. A 61-year-old woman with stage IIB cervical cancer underwent a combination of external beam radiotherapy (EBRT) at a dose of 50.4 Gy in 28 fractions and 2D-ICBT at a dose of 22 Gy in four fractions. As packs were well inserted around the uterus in all fractions of 2D-ICBT, the doses to the surrounding organs at risk (OAR) could be likely to be kept at low levels. She developed a huge fistula between the vagina and bladder approximately 2.5 years after radiotherapy (RT). She also developed a fistula between the vagina and small bowel approximately seven years after RT and underwent bypass from the small bowel to the transverse colon. The OAR were delineated using computed tomography for EBRT planning, and the cumulative dose of 2D-ICBT plus EBRT was evaluated as the source of toxicity. The cumulative dose converted to the equivalent dose in 2-Gy fractions (EQD2) was calculated using the linear-quadratic model with α/β = 3 for the OAR. The cumulative EQD2 values of the minimum dose to the most irradiated 2 cc (D2cc) of the bladder and small bowel were 90.2 Gy and 79.5 Gy, respectively. These values exceeded the upper limits of the dosimetric criteria of the OAR, suggesting an association with both vaginal fistulas. As the adoption of IGBT is too slow in some countries, it is noteworthy that a reduced bladder volume may result in a significant increase in the dose to the small bowel and bladder in 2D-ICBT.

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Efficacy and Safety of Argon Plasma Coagulation for Hemorrhagic Chronic Radiation Proctopathy: A Systematic Review

Cited by 16 publications

References 48 publications

Efficacy and complications of argon plasma coagulation for hemorrhagic chronic radiation proctitis

Efficacy and complications of argon plasma coagulation for hemorrhagic chronic radiation proctitis

Risk Prediction and Treatment of Hemorrhagic Chronic Radiation Intestinal Injury Patients With LE-DVT

Vaginal Fistulas of the Bladder and Small Bowel After Two-Dimensional Intracavitary Brachytherapy in a Patient With Cervical Cancer

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