• chronic radiation proctopathy
• endoscopic therapy

• Humans
• Radiation Injuries/therapy
• Radiation Injuries/surgery
• Radiation Injuries/etiology
• Argon Plasma Coagulation/methods
• Chronic Disease
• Treatment Outcome
• Randomized Controlled Trials as Topic
• Radiotherapy/adverse effects
• Female
• Male

• Acute late toxicity
• Follow-up
• Gynecological cancers
• Prevention
• Radiotherapy
• Treatment

• Humans
• Female
• Genital Neoplasms, Female/radiotherapy
• Radiation Injuries/prevention & control
• Radiation Injuries/etiology
• Italy
• Organs at Risk/radiation effects
• Radiotherapy/adverse effects
• Societies, Medical
• Radiation Oncology

• Università degli Studi di Perugia

• Humans
• Cryosurgery/methods
• Endoscopy, Gastrointestinal/methods
• Barrett Esophagus/surgery
• Barrett Esophagus/therapy
• Cryotherapy/methods
• Esophageal Neoplasms/surgery
• Esophageal Neoplasms/therapy
• Treatment Outcome
• Gastrointestinal Hemorrhage/therapy
• Gastrointestinal Hemorrhage/etiology
• Esophageal Stenosis/therapy
• Esophageal Stenosis/surgery
• Esophageal Stenosis/etiology

• Guidelines
• Quality evaluation
• Radiation enteritis
• Treatment

• Barrett’s esophagus
• Cryotherapy
• Esophageal cancer
• Gastric antral vascular ectasia
• Palliative therapy

Changrui enema, a traditional Chinese medicine prescription, is used as a supplementary treatment for acute radiation proctitis (ARP). Herein we explored the inhibition effects of Changrui enema on NF-κB and VEGF in ARP mice.

A total of 120 C57BL/6 mice were divided randomly into normal mice group, ARP mice group, western medicine enema group (dexamethasone combined with gentamicin), and Changrui enema group. ARP mice were established by pelvic local irradiation. The expression of IL-1β, NF-κB, VEGF, AQP1, AQP3, p-ERK1/2 and p-JNK was determined by immunohistochemistry or western blot.

The study firstly found that Changrui enema alleviated ARP mice. The expression of IL-1β, NF-κB, VEGF, AQP1 and p-ERK1/2 was increased in ARP mice, and was reserved by Changrui enema. However, the expression of AQP3 and p-JNK was decreased in ARP mice, and was up-regulated by Changrui enema.

Changrui enema is an effective treatment with fewer side effects for ARP. The mechanism of Changrui enema may be related to the inhibition of inflammation-induced angiogenesis. Changrui enema inhibits IL-1β and NF-κB expression as well as VEGF expression. Interestingly, AQP1 promotes angiogenesis, while AQP3 inhibits inflammation. Changrui enema probably inhibits AQP1 expression by down-regulating p-ERK1/2, and improves AQP3 expression by up-regulating p-JNK.

• Chronic Disease
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/surgery
• Humans
• Proctoscopy/standards
• Radiation Injuries/complications
• Radiation Injuries/surgery
• Rectal Diseases/etiology
• Rectal Diseases/surgery
• Rectum/injuries

• Endoscopic therapy
• Medical therapy
• Radiation proctitis
• Surgical therapy

• VEGF
• pelvic malignancies
• radiation proctitis
• radiotherapy

• Barrx
• endoscopic treatment
• gastric antral vascular ectasia
• radiofrequency ablation

In the last decade, the treatment of dysplastic Barrett’s esophagus has evolved into primarily endoscopic therapy. Many techniques have become well-established to destroy or remove the mucosal lining of Barrett’s esophagus. One of the newest therapies, cryospray ablation, has become a modality to treat both dysplastic Barrett’s esophagus as well as esophageal carcinoma. In endoscopic applications, the cryogen used is either liquid nitrogen or carbon dioxide which causes tissue destruction through rapid freeze-thaw cycles. Unlike other endoscopic ablation techniques, its unique mechanism of action and depth of tissue injury allow cryoablation to be used effectively in flat or nodular disease. It can be combined with other modalities such as endoscopic mucosal resection or radiofrequency ablation. Its esophageal applications stem well-beyond Barrett’s into ablation of early carcinoma, palliative debulking of advanced carcinoma and reduction of tumor ingrowth into stents placed for dysphagia. Although there are fewer reported studies of endoscopic cryoablation in the literature compared to other endoscopic ablation methods, emerging research continues to demonstrate its efficacy as a durable ablation technology with a variety of applications. The aim of this review is to examine the pathophysiology of endoscopic cryospray ablation, describe its outcomes in Barrett’s with dysplasia and esophageal carcinoma, and examine its role in other gastrointestinal applications such as hemostasis in the stomach and rectum.

• Barrett’s esophagus
• Dysplasia
• Esophageal carcinoma
• Endoscopic cryoablation
• Cryotherapy

Chronic haemorrhagic radiation proctitis (CHRP) is a difficult problem faced by the patients following radiation for pelvic malignancy. There is no standard treatment for this condition, but many methods of treatment are available. The aim of this study was to review the literature to see whether there is an improvement in the available evidence in comparison with previously published systematic reviews in treating patients with CHRP. The PubMed/Medline database and Google Scholar search was selectively searched. Studies, which treated patients with rectal bleeding due to chronic radiation proctitis or CHRP, were included. Seventy studies were finally selected out of which 14 were randomized controlled clinical trials. Though these studies could not be compared, it could be seen that there was an improvement in the methodology of the studies. There was an objective assessment of symptoms, signs and an objective assessment of outcomes. But, still, there were only a few studies that looked into the quality of life following treatment of CHRP. To increase recruitment to trials, a national registry of cases with established late radiation toxicity would facilitate the further improvement of such studies. Some of the conclusions that could be reached based on the available evidence are 4% formalin should be the first line treatment for patients with CHRP. Formalin and argon plasma coagulation (APC) are equally effective, but formalin is better for severe disease. Refractory patients, not responding to formalin or APC, need to be referred for hyperbaric oxygen therapy or surgery. Radio-frequency ablation is a promising modality that needs to be studied further in randomized trials.

• Radiotherapy
• Complications
• Systematic review
• Proctitis
• Formalin

• Endoscopic
• Medical
• Proctopathy
• Steroids
• Surgery

• Argon plasma coagulation
• Bipolar probe
• Cryotherapy
• Endoscopic treatment
• Formalin
• Laser
• Pelvic radiotherapy
• Proctitis
• Radiation proctopathy
• Radiofrequency ablation

A mucocele is a common salivary gland disorder that most commonly affects young adults. A 35-year-old female patient reported to the Department of Oral and Maxillofacial Surgery, with the chief complaint of swelling on the left side of floor of mouth. The aim of this case report is to present the management of mucocele present in floor of the mouth in a young female patient using liquid nitrogen cryosurgery. The present case report has also discussed mechanism of action, current protocol of cryosurgery with emphasis on clinical pros and cons along with the clinical outcomes.

• Cryotherapy
• liquid nitrogen
• mucocele
• ranula

Pelvic cancers are among the most frequently diagnosed neoplasms and radiotherapy represents one of the main treatment options. The irradiation field usually encompasses healthy intestinal tissue, especially of distal large bowel, thus inducing gastrointestinal (GI) radiation-induced toxicity. Indeed, up to half of radiation-treated patients say that their quality of life is affected by GI symptoms (e.g., rectal bleeding, diarrhoea). The constellation of GI symptoms - from transient to long-term, from mild to very severe - experienced by patients who underwent radiation treatment for a pelvic tumor have been comprised in the definition of pelvic radiation disease (PRD). A correct and evidence-based therapeutic approach of patients experiencing GI radiation-induced toxicity is mandatory. Therapeutic non-surgical strategies for PRD can be summarized in two broad categories, i.e., medical and endoscopic. Of note, most of the studies have investigated the management of radiation-induced rectal bleeding. Patients with clinically significant bleeding (i.e., causing chronic anemia) should firstly be considered for medical management (i.e., sucralfate enemas, metronidazole and hyperbaric oxygen); in case of failure, endoscopic treatment should be implemented. This latter should be considered the first choice in case of acute, transfusion requiring, bleeding. More well-performed, high quality studies should be performed, especially the role of medical treatments should be better investigated as well as the comparative studies between endoscopic and hyperbaric oxygen treatments.

• Pelvic radiation disease
• Radiation-induced proctopathy
• Radiotherapy
• Gastrointestinal toxicity
• Sucralfate
• Metronidazole
• Probiotics
• Argon plasma coagulation
• Hyperbaric oxygen
• Formalin

• diagnosis
• proctitis
• radiation
• treatment

Radiation proctopathy is a complication of pelvic radiotherapy, which occurs in patients treated for carcinoma of the prostate, rectum, urinary bladder, cervix, uterus, and testes. If it presents within 6 weeks to 9 months after therapy, it is called acute radiation proctitis/proctopathy (ARP), and if it occurs 9 months to a year after treatment, it is classified as chronic radiation proctitis/proctopathy (CRP). CRP occurs in 5%–20% of patients receiving pelvic radiation, depending on the radiation dose and the presence or absence of chemotherapy. In many cases, CRP resolves spontaneously, but in some, it can lead to persistent rectal bleeding. Other symptoms of CRP include diarrhea, mucoid discharge, urgency, tenesmus, rectal pain, and fecal incontinence. Despite the availability of several therapies, many patients fail to respond, and continue to suffer in their quality of life. Radiofrequency ablation (RFA) is a newer endoscopic technique that uses radiofrequency energy to ablate tissue. This is an emerging way to treat radiation proctopathy and other mucosal telangiectasia. We present three cases of radiation proctopathy treated with RFA at our institute and review the literature on treatment modalities for CRP. We were also able to find 16 other cases of CRP that used RFA, and review their literature as well as literature on other treatment modalities.

• BarRx
• Halo catheter
• radiation proctopathy
• radiofrequency ablation

• Argon plasma coagulation
• Endoscopic laser therapy
• Formalin
• Hyperbaric oxygen
• Radiation colitis
• Radiation proctitis
• Short-chain fatty acids
• Sucralfate

• Argon plasma coagulation
• Cryoablation
• Endoscopic treatment
• Formalin application
• Radiation proctitis
• Radiofrequency ablation

• Radiation proctitis
• gastrointestinal bleeding
• proctopathy
• radiofrequency ablation

Chronic radiation proctopathy occurs in 5%-20% of patients following pelvic radiotherapy. Although many cases resolve spontaneously, some lead to chronic symptoms including diarrhea, tenesmus, urgency and persistent rectal bleeding with iron deficiency anemia requiring blood transfusions. Treatments for chronic radiation proctitis remain unsatisfactory and the basis of evidence for various therapies is generally insufficient. There are very few controlled or prospective trials, and comparisons between therapies are limited because of different evaluation methods. Medical treatments, including formalin, topical sucralfate, 5-amino salicylic acid enemas, and short chain fatty acids have been used with limited success. Surgical management is associated with high morbidity and mortality. Endoscopic therapy using modalities such as the heater probe, neodymium:yttrium-aluminium-garnet laser, potassium titanyl phosphate laser and bipolar electrocoagulation has been reported to be of some benefit, but with frequent complications. Argon plasma coagulation is touted to be the preferred endoscopic therapy due to its efficacy and safety profile. Newer methods of endoscopic ablation such as radiofrequency ablation and cryotherapy have been recently described which may afford broader areas of treatment per application, with lower rate of complications. This review will focus on endoscopic ablation therapies, including such newer modalities, for chronic radiation proctitis.

• Chronic
• Radiation proctitis
• Endoscopic
• Argon plasma coagulation
• Radiofrequency
• Cryoablation