Complication and remission rates after endoscopic argon plasma coagulation in the treatment of haemorrhagic radiation proctitis

Abstract

Purpose The management of haemorrhagic radiation proctitis is challenging because of the necessity for repeated intervention. The efficacy of argon plasma coagulation has been described before but the optimum treatment strategy remains debatable. This is a review of our experience over a decade treating patients with haemorrhagic radiation proctitis and their follow-up. Methods This is a retrospective review of consecutive patients who underwent argon plasma coagulation for haemorrhagic radiation proctitis between January 2003 and December 2013. The patients were followed up using a prospectively maintained database. Results Ninety-one patients were included with a mean follow-up of 13.1 months. Majoity (n = 85, 93.4 %) of the patients were female. Mean age at the time of treatment was 58.2 (range 23-87) years old. Majority of the patients (n = 73, 80.2 %) received radiotherapy for gynaecological malignancies followed by colorectal (n = 13, 14.3 %) and urological (n = 5, 5.5 %) malignancies. Mean interval between radiation and proctitis was 13.8 (range 3-40) months. Seventy-nine percent of patients were successfully treated after 1-2 sessions. Seventeen (18.7 %) patients experienced self-limiting early complications, and three (3.3 %) had late complications of rectal stenosis which was managed conservatively. Severity of bleeding during the initial presentation is an independent factor that predicts the number of sessions required for successful haemostasis (p = 0.002). Conclusions Argon plasma coagulation is a reasonable treatment option in patients with haemorrhagic radiation proctitis with good safety profile. Our study suggests that the number of APC sessions required to arrest bleeding correlates with the severity of bleeding on initial presentation.

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

“…The efficacy of APC in our study seemed to be less than that observed in some prior studies[22-24]. Two main reasons may contribute to this.…”

“…In a series of 50 patients, Swan et al[26] found that the endoscopic grade did not predict the likelihood of treatment success. A study by Siow et al[22] also suggested that endoscopic grading was not a predictor of the number of APC sessions needed to achieve hemostasis. However, Zinicola et al[18] suggested that endoscopic severity could predict the success of APC.…”

ASGE guideline on the role of endoscopy for bleeding from chronic radiation proctopathy

“…However, most studies in this systematic review used the firstgeneration APC machine (ICC/APC 300 system; Erbe Elektromedizin, Tuebingen, Germany), which may not be available in most endoscopy units. 16,18,19,21,[24][25][26]28,29,32,33,37,39,40,44,46,48 Only 3 studies used the second-generation APC machine (VIO APC/APC 2; Erbe Elektromedizin). 17,31,46 Comparative studies.…”

Changrui enema inhibits inflammation-induced angiogenesis in acute radiation proctitis by regulating NF-κB and VEGF

“…Apart from medical therapies, hyperbaric Oxygen appears to be an effective therapy for radiation proctitis according to some clinical trials 25 . In addition, endoscopic therapies have also been developed for the treatment of radiation proctitis, including laser therapies 26 , 27 , argon plasma coagulation 28 , 29 , radiofrequency ablation 30 , 31 and cryoablation 32 , 33 . However, these therapies of radiation proctitis still remain unsatisfactory and novel treatments are urgently needed.…”