Published online Feb 28, 2020. doi: 10.3748/wjg.v26.i8.850
Peer-review started: October 30, 2019
First decision: November 22, 2019
Revised: December 4, 2019
Accepted: February 15, 2020
Article in press: February 15, 2020
Published online: February 28, 2020
Processing time: 120 Days and 15.1 Hours
Severe chronic radiation proctopathy (CRP) is difficult to treat.
To evaluate the efficacy of colostomy and stoma reversal for CRP.
To assess the efficacy of colostomy in CRP, patients with severe hemorrhagic CRP who underwent colostomy or conservative treatment were enrolled. Patients with tumor recurrence, rectal-vaginal fistula or other types of rectal fistulas, or who were lost to follow-up were excluded. Rectal bleeding, hemoglobin (Hb), endoscopic features, endo-ultrasound, rectal manometry, and magnetic resonance imaging findings were recorded. Quality of life before stoma and after closure reversal was scored with questionnaires. Anorectal functions were assessed using the CRP symptom scale, which contains the following items: Watery stool, urgency, perianal pain, tenesmus, rectal bleeding, and fecal/gas incontinence.
A total of 738 continual CRP patients were screened. After exclusion, 14 patients in the colostomy group and 25 in the conservative group were included in the final analysis. Preoperative Hb was only 63 g/L ± 17.8 g/L in the colostomy group compared to 88.2 g/L ± 19.3 g/L (P < 0.001) in the conservative group. All 14 patients in the former group achieved complete remission of bleeding, and the colostomy was successfully reversed in 13 of 14 (93%), excepting one very old patient. The median duration of stoma was 16 (range: 9-53) mo. The Hb level increased gradually from 75 g/L at 3 mo, 99 g/L at 6 mo, and 107 g/L at 9 mo to 111 g/L at 1 year and 117 g/L at 2 years after the stoma, but no bleeding cessation or significant increase in Hb levels was observed in the conservative group. Endoscopic telangiectasia and bleeding were greatly improved. Endo-ultrasound showed decreased vascularity, and magnetic resonance imaging revealed an increasing presarcal space and thickened rectal wall. Anorectal functions and quality of life were significantly improved after stoma reversal, when compared to those before stoma creation.
Diverting colostomy is a very effective method in the remission of refractory hemorrhagic CRP. Stoma can be reversed, and anorectal functions can be recovered after reversal.
Core tip: This study evaluated the efficacy of colostomy and stoma reversal in severe chronic hemorrhagic radiation proctopathy. After screening 738 patients, 14 patients in the colostomy group and 25 in the conservative treatment group were included. All 14 colostomy patients achieved complete remission of bleeding, and the colostomy was reversed in 13 patients. The hemoglobin level increased gradually after the stoma. However, no bleeding cessation was observed in the conservative group. Anorectal functions and quality of life were improved after stoma reversal. In conclusion, diverting colostomy is an effective option and can be reversed in severe chronic hemorrhagic radiation proctopathy.