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Haemorrhagic radiation proctitis: endoscopic severity may be useful to guide therapy

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International Journal of Colorectal Disease Aims and scope Submit manuscript

An Erratum to this article was published on 12 March 2004

Abstract

Background and aims

Management of haemorrhagic radiation proctitis remains controversial. Both endoscopically delivered argon plasma coagulation and rectal administration of formalin have been recommended. We evaluated the efficacy of argon plasma coagulation according to endoscopic severity of radiation proctitis.

Patients and methods

Fourteen patients treated with argon plasma coagulation for rectal bleeding due to radiation proctitis were reviewed. Patients were classified with a new endoscopic score for haemorrhagic radiation proctitis, comprising three factors: telangiectasia distribution, surface area involved, and presence of fresh blood. Seven patients were categorised as having grade A (mild), four grade B (moderate), and three grade C (severe) radiation proctitis. Rectal bleeding was assessed pre- and post-treatment using a five-point bleeding scale.

Results

All patients with grade A and B radiation proctitis were treated successfully by argon plasma coagulation (mean 1.5 sessions). In one patient with grade C radiation proctitis argon plasma coagulation was successful after four sessions, but in the other two patients bleeding could not be controlled; a subsequent single formalin administration was successful in both. Overall in 12 patients (85.7%) bleeding ceased or improved significantly. The mean rectal bleeding scale reduced significantly from 2.6 to 0.9. One patient treated with argon plasma coagulation developed an asymptomatic rectosigmoid stenosis.

Conclusion

Argon plasma coagulation is a simple, safe and efficacious therapy for mild/moderate radiation proctitis. In patients with severe radiation proctitis several sessions are usually necessary, and success is not certain; in these cases, topical formalin administration may be more effective. Endoscopic severity of haemorrhagic radiation proctitis may be useful to guide appropriate therapy.

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References

  1. Saclarides TJ, King DG, Franklin JL, Doolas A (1996) Formalin instillation for refractory radiation-induced hemorrhagic proctitis. Report of 16 patients. Dis Colon Rectum 39:196–199

    CAS  PubMed  Google Scholar 

  2. Silva RA, Correia AJ, Dias LM, Viana HL, Viana RL (1999) Argon plasma coagulation therapy for hemorrhagic radiation proctosigmoiditis. Gastrointest Endosc 50:221–224

    CAS  PubMed  Google Scholar 

  3. Cunningham IG (1980) The management of radiation proctitis. Aust N Z J Surg 50:172–178

    CAS  PubMed  Google Scholar 

  4. Deitel M, Vasic V (1979) Major intestinal complications of radiotherapy. Am J Gastroenterol 72:65–70

    CAS  PubMed  Google Scholar 

  5. Gilinsky NH, Burns DG, Barbezat GO, Levin W, Myers HS, Marks IN (1983) The natural history of radiation-induced proctosigmoiditis: an analysis of 88 patients. Q J Med 52:40–53

    CAS  PubMed  Google Scholar 

  6. Haboubi NY, Schofield PF, Rowland PL (1988) The light and electron microscopic features of early and late phase radiation-induced proctitis. Am J Gastroenterol 83:1140–1144

    CAS  PubMed  Google Scholar 

  7. Hasleton PS, Carr N, Schofield PF (1985) Vascular changes in radiation bowel disease. Histopathology 9:517–534

    CAS  PubMed  Google Scholar 

  8. Baum CA, Biddle WL, Miner PB Jr (1989) Failure of 5-aminosalicylic acid enemas to improve chronic radiation proctitis. Dig Dis Sci 34:758–760

    CAS  PubMed  Google Scholar 

  9. Kochhar R, Patel F, Dhar A, Sharma SC, Ayyagari S, Aggarwal R, Goenka MK, Gupta BD, Mehta SK (1991) Radiation-induced proctosigmoiditis. Prospective, randomized, double-blind controlled trial of oral sulfasalazine plus rectal steroids versus rectal sucralfate. Dig Dis Sci 36:103–107

    CAS  PubMed  Google Scholar 

  10. Kochhar R, Sriram PV, Sharma SC, Goel RC, Patel F (1999) Natural history of late radiation proctosigmoiditis treated with topical sucralfate suspension. Dig Dis Sci 44:973–978

    CAS  PubMed  Google Scholar 

  11. Talley NA, Chen F, King D, Jones M, Talley NJ (1997) Short-chain fatty acids in the treatment of radiation proctitis: a randomized, double-blind, placebo-controlled, cross-over pilot trial. Dis Colon Rectum 40:1046–1050

    CAS  PubMed  Google Scholar 

  12. Kitta T, Shinohara N, Shirato H, Otsuka H, Koyanagi T (2000) The treatment of chronic radiation proctitis with hyperbaric oxygen in patients with prostate cancer. BJU Int 85:372–374

    Article  CAS  PubMed  Google Scholar 

  13. Woo TC, Joseph D, Oxer H (1997) Hyperbaric oxygen treatment for radiation proctitis. Int J Radiat Oncol Biol Phys 38:619–622

    Article  CAS  PubMed  Google Scholar 

  14. Stuart M, Failes DG, Killingback MJ, De Luca C (1980) Irradiation injuries of the large intestine. Dis Colon Rectum 23:94–97

    CAS  PubMed  Google Scholar 

  15. Dirksen PK, Matolo NM, Trelford JD (1977) Complications following operation in the previously irradiated abdominopelvic cavity. Am Surg 43:234–241

    CAS  PubMed  Google Scholar 

  16. Lucarotti ME, Mountford RA, Bartolo DC (1991) Surgical management of intestinal radiation injury. Dis Colon Rectum 34:865–869

    CAS  PubMed  Google Scholar 

  17. Fantin AC, Binek J, Suter WR, Meyenberger C (1999) Argon beam coagulation for treatment of symptomatic radiation-induced proctitis. Gastrointest Endosc 49:515–518

    CAS  PubMed  Google Scholar 

  18. Tam W, Moore J, Schoeman M (2000) Treatment of radiation proctitis with argon plasma coagulation. Endoscopy 32:667–672

    Article  CAS  PubMed  Google Scholar 

  19. Venkatesh KS, Ramanujam P (2002) Endoscopic therapy for radiation proctitis-induced hemorrhage in patients with prostatic carcinoma using argon plasma coagulator application. Surg Endosc 16:707–710

    Article  CAS  PubMed  Google Scholar 

  20. Counter SF, Froese DP, Hart MJ (1999) Prospective evaluation of formalin therapy for radiation proctitis. Am J Surg 177:396–398

    Article  CAS  PubMed  Google Scholar 

  21. Mathai V, Seow-Choen F (1995) Endoluminal formalin therapy for haemorrhagic radiation proctitis. Br J Surg 82:190

    CAS  PubMed  Google Scholar 

  22. Seow-Choen F, Goh HS, Eu KW, Ho YH, Tay SK (1993) A simple and effective treatment for hemorrhagic radiation proctitis using formalin. Dis Colon Rectum 36:135–138

    CAS  PubMed  Google Scholar 

  23. Ismail MA, Qureshi MA (2002) Formalin dab for haemorrhagic radiation proctitis. Ann R Coll Surg Engl 84:263–264

    Article  CAS  PubMed  Google Scholar 

  24. Kaassis M, Oberti E, Burtin P, Boyer J (2000) Argon plasma coagulation for the treatment of hemorrhagic radiation proctitis. Endoscopy 32:673–676

    Article  CAS  PubMed  Google Scholar 

  25. Ouwendijk R, Tetteroo GW, Bode W, de Graaf EJ (2002) Local formalin instillation: an effective treatment for uncontrolled radiation-induced hemorrhagic proctitis. Dig Surg 19:52–55

    Article  CAS  PubMed  Google Scholar 

  26. Taylor JG, Disario JA, Bjorkman DJ (2000) KTP laser therapy for bleeding from chronic radiation proctopathy. Gastrointest Endosc 52:353–357

    CAS  PubMed  Google Scholar 

  27. Luna-Perez P, Rodriguez-Ramirez SE (2002) Formalin instillation for refractory radiation-induced hemorrhagic proctitis. J Surg Oncol 80:41–44

    Article  CAS  PubMed  Google Scholar 

  28. Pikarsky AJ, Belin B, Efron J, Weiss EG, Nogueras JJ, Wexner SD (2000) Complications following formalin installation in the treatment of radiation induced proctitis. Int J Colorectal Dis 15:96–99

    Article  CAS  PubMed  Google Scholar 

  29. Taieb S, Rolachon A, Cenni JC, Nancey S, Bonvoisin S, Descos L, Fournet J, Gerard JP, Flourie B (2001) Effective use of argon plasma coagulation in the treatment of severe radiation proctitis. Dis Colon Rectum 44:1766–1771

    CAS  PubMed  Google Scholar 

  30. Villavicencio RT, Rex DK, Rahmani E (2002) Efficacy and complications of argon plasma coagulation for hematochezia related to radiation proctopathy. Gastrointest Endosc 55:70–74

    Article  PubMed  Google Scholar 

  31. Chapuis P (2001) Challenge of chronic radiation-induced rectal bleeding. A NZ J Surg 71:200–201

    Article  CAS  Google Scholar 

  32. Tjandra JJ, Sengupta S (2001) Argon plasma coagulation is an effective treatment for refractory hemorrhagic radiation proctitis. Dis Colon Rectum 44:1759–1765

    CAS  PubMed  Google Scholar 

  33. Saclarides TJ (2001) Invited commentary: effective use of argon plasma coagulation in the treatment of severe radiation proctitis. Dis Colon Rectum 44:1771

    Google Scholar 

  34. Chutkan R, Lipp A, Waye J (1997) The argon plasma coagulator: a new and effective modality for treatment of radiation proctitis (abstract). Gastrointest Endosc 45:11

    Google Scholar 

  35. Correia JM, Pinto A, Pereira AD, Nobre C, Costa Mira L F (1994) Successful treatment of haemorrhagic radiation proctitis with formalin irrigation (abstract). Gastroenterology 106

  36. Biswal BM, Lal P, Rath GK, Shukla NK, Mohanti BK, Deo S (1995) Intrarectal formalin application, an effective treatment for grade III haemorrhagic radiation proctitis. Radiother Oncol 35:212–215

    Article  CAS  PubMed  Google Scholar 

  37. Faragher I, Bailey H (1997) Topical formalin: a simple and effective treatment of haemorrhagic radiation proctitis (abstract). Dis Colon Rectum 40

    Google Scholar 

  38. Coyoli GO, Alvarado CR, Corona BA, Pacheco PM (1999) The treatment of rectorrhagia secondary to postradiation proctitis with 4% formalin. Ginecol Obstet Mex 67:345

    Google Scholar 

  39. Yegappan M, Ho YH, Nyam D, Leong A, Eu KW, Seow C (1998) The surgical management of colorectal complications from irradiation for carcinoma of the cervix. Ann Acad Med Singapore 27:627–630

    CAS  PubMed  Google Scholar 

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Acknowledgements

A preliminary report of this study was presented at the annual meeting of British Society of Gastroenterology in Birmingham, 17–20 March 2002.

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Correspondence to Brian P. Saunders.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s00384-004-0582-8

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Zinicola, R., Rutter, M.D., Falasco, G. et al. Haemorrhagic radiation proctitis: endoscopic severity may be useful to guide therapy. Int J Colorectal Dis 18, 439–444 (2003). https://doi.org/10.1007/s00384-003-0487-y

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  • DOI: https://doi.org/10.1007/s00384-003-0487-y

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