Editorial
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World J Gastrointest Endosc. Jul 16, 2013; 5(7): 308-312
Published online Jul 16, 2013. doi: 10.4253/wjge.v5.i7.308
Endoscopic treatments for chronic radiation proctitis
George Karamanolis, Panagiota Psatha, Konstantinos Triantafyllou
George Karamanolis, Gastroenterology Unit, 2nd Department of Surgery, “Aretaieio” University Hospital, Athens University, 11528 Athens, Greece
George Karamanolis, Panagiota Psatha, Konstantinos Triantafyllou, Hepatogastroenterology Unit, 2nd Department of Internal Medicine and Research Institute, “Attikon” University General Hospital, Athens University, 12462 Athens, Greece
Author contributions: All authors have equally contributed to conception and design, acquisition of data, drafting the article and final approval of the version to be published.
Correspondence to: Dr. Konstantinos Triantafyllou, Hepatogastroenterology Unit, 2nd Department of Internal Medicine and Research Institute, “Attikon” University General Hospital, Rimini 1, Haidari, 12462 Athens, Greece. ktriant@med.uoa.gr
Telephone: +30-210-5832090 Fax: +30-210-5326422
Received: February 24, 2013
Revised: May 29, 2013
Accepted: June 18, 2013
Published online: July 16, 2013
Processing time: 142 Days and 6.2 Hours
Abstract

Chronic radiation proctitis is a complication that occurs in patients who receive radiation therapy for pelvic malignancies. The common presentation is with rectal bleeding, but also rectal pain, diarrhea, tenesmus and even passage of mucus can occur. The optimal treatment of bleeding due to radiation proctitis remains unclear. Among various therapeutic options, medical management is generally ineffective and surgical intervention has a high incidence of morbidity. Promising advances have been made in endoscopic therapy, including argon plasma coagulation (APC), formalin application as well as new techniques such as radiofrequency ablation and cryoablation. APC is a safe, highly effective and long-lasting therapy in patients with rectal bleeding associated with radiation proctitis. It has been shown that several sessions of APC reduce the rate of bleeding and therefore the blood transfusion requirements. Moreover, the effect of treatment is long lasting. However, best results are achieved in patients with mild to moderate radiation proctitis, leaving space for alternative treatments for patients with more severe disease. In patients with severe or refractory radiation proctitis intra rectal formalin application is an appropriate treatment option. Radiofrequency ablation and cryoablation have shown efficacy as alternative methods in a limited number of patients with refractory chronic radiation proctitis.

Keywords: Radiation proctitis; Endoscopic treatment; Argon plasma coagulation; Formalin application; Cryoablation; Radiofrequency ablation

Core tip: Chronic radiation proctitis presents with rectal bleeding, pain, diarrhea, tenesmus and passage of mucus. Among other therapeutic options, endoscopic therapy with argon plasma coagulation (APC) is a safe and highly effective in patients with rectal bleeding associated with radiation proctitis. Although best results are achieved in patients with mild to moderate lesions, APC therapy reduces the rate of bleeding and blood transfusion requirements and its effect last for long. In patients with severe or refractory radiation proctitis intra rectal formalin application,radiofrequency ablation and cryoablation have shown efficacy in a limited number of patients.