Management of chronic hemorrhagic radiation proctitis

Abstract

Rectal bleeding secondary to radiation proctitis is the most dreaded complication of pelvic radiotherapy. Its management remains a perplexing problem despite the availability of multiple treatment modalities. Patients are usually managed on a "hit and miss" basis at most centers. Steroid, 5-aminosalicylic acid, short chain fatty acids and sucralfate enemas, hyperbaric oxygen therapy, and topical application of 4% formaldehyde all have been used with varying results. Surgical procedures such diversion colostomy or resection of involved segment have been proposed for refractory bleeding. Endoscopic methods are being increasingly adopted in the form of bipolar electrocoagulation, heat probe coagulation, photoablation, Nd:YAG laser and preferably argon plasma coagulation. The utility of conservative approaches remains far below desirable levels. Onset of hemorrhagic recurrence represents a major obstacle that leads to a need for repeated therapeutic sessions and sometimes invocation of radical techniques. This review discusses various treatment modalities and aims to identify their efficacy and limitations. A critical review was conducted of published reports regarding management of chronic hemorrhagic radiation proctitis (CHRP). Although there are few prospective randomized trials, enough evidence is available to conclude that argon plasma coagulation represents the current treatment of choice.

What pelvic radiation disease symptoms are experienced by patients receiving external beam radiotherapy and a high-dose-rate brachytherapy boost for prostate cancer?

“…While the reported incidence of pelvic radiation disease is low, symptoms beyond rectal bleeding include abdominal pain, diarrhea, fecal and/or mucous incontinence, tenesmus, extreme bowel urgency, constipation or dyschezia, and blood clots [ 16 , 17 , 18 , 19 ]. Aside from physical side effects, patients who have received brachytherapy may also experience decreased: life satisfaction; sense of security, and self-esteem [ 20 ].…”

Formalin dab for treatment of haemorrhagic radiation proctitis

“…Other advantages of formalin application are low cost, low incidence of side-effects, ready availabilityand easy application 7. In most cases, formalin therapy can be performed in the outpatient or day surgery setting, without anaesthesia 8.…”

Role of Laparoscopy in Radiation Proctitis: Case Report and Review of Literature

“…The disease manifests as abdominal pain, tenesmus, diarrhea, incontinence and urgency and these symptoms may resolve spontaneously. The chronic radiation proctitis is caused after 3 months of radiation exposure almost takes 8 -10 months to develop (2). The incidence is also related to the dose of radiation given, area of exposure and mode of delivery of radiation along with the use of cryoprotective agents.…”