Chronic radiation proctitis – does argon plasma coagulation (APC) resolve this therapeutic problem?

Česká verze

Authors: J. Záň ¹; I. Katuščák ²; I. Minčík ¹; D. Bestvina ¹
Authors place of work: Interná klinika – gastroenterologické pracovisko, ÚVN SNP – FN Ružomberok ¹; Martinské centrum gastroenterológie, Martin ²
Published in the journal: Gastroent Hepatol 2011; 65(6): 316-324
Category: Klinická a experimentální gastroenterologie: původní práce

Summary

Chronic radiation proctitis (ChRP) is a serious complication of pelvic radiotherapy. Its leading symptom is rectal bleeding which can be difficult to control. Medicamentous therapy has controversial or very short effect, endoscopic therapy is either very expensive (laser) or it has very frequent and substantial complication (formalin).

Aim of study:
In this prospective study we have evaluated the efficiency of argon plasma coagulation in treatment of chronic radiation proctitis as well as safety of this method and longterm outcomes.

Material and methods:
Thirty one consecutive patients with chronic radiation proctitis were treated with argon plasma coagulation with standart protocol from September 2002 to July 2007. They didn´t undergo other types of endoscopic therapy in the past. We monitored each patient’s hemorrhage intensity, hemoglobin level, number of defecations, tenesmus and rectum pain intensity before, during and after the treatment by means of evaluation scores. After treatment control endoscopy was performed.

Results:
75 therapeutic APC session were performed (mean 2,4 per patient). Rectal bleeding severity score was reduced from 3,29 to 0,10 (p < 0,001). In correlation with the treatment ChRP mean hemoglobin level was rising from 118 g/l to 134 g/l (p < 0,001). Also other symptoms of CRP were decreased by APC. There was no hemorrhage recurrence during the median follow-up of 17 months (1–42 months). None of patients experienced any significant side effect or complication during the treatment and endoscopic monitoring.

Conclusion:
Argon plasma coagulation is an efective and safe treatment for pacients with chronic radiation proctitis.

Key words:
chronic radiation proctitis – rectal bleeding – therapeutic endoscopy – argon plasma coagulation

Zdroje

1. Ginsberg GG, Kochman ML, Norton I et al. Clinical gastrointestinal endoscopy. Elsevier Saunders 2005: 185–194, 213–237, 311–332.

2. Taieb S, Rolachon A, Cenni JC et al. Effective use of Argon plasma coagulation in the treatment of severe radiation proctitis. Dis Colon Rectum 2001; 44(12): 1766–1771.

3. Urban O, Chalupa J, Vítek P et al. Léčba chronické postradiační proktitídy argonovou plazmakoagulací. Vnitř lék 2004; 50(3): 218–221.

4. Tjandra JJ, Sengupta S. Argon plasma coagulation is an effective treatment for refractory hemorrhagic radiation proctitis. Dis Colon Rectum 2001; 44(12): 1759–1765.

5. Johnston MJ, Robertson GM, Frizelle FA. Management of late complications of pelvic radiation in the rectum and anus: a review. Dis Colon Rectum 2003; 46(2): 247–259.

6. Postgate A, Saunders B, Tjandra J. Argon plasma coagulation in chronic radiation proctitis. Endoscopy 2007; 39(4): 361–365.

7. Olmos JA, Marcolongo M, Pogorelsky V et al. Argon plasma coagulation for prevention of recurrent bleeding from GI angiodysplasias. Gastrointest Endosc 2004; 60(4): 881–886.

8. Grund KE, Zindel C, Farin G. Argon plasma coagulation through flexible endoscope. Evaluation of a new therapeutic method after 1606 uses. Dtsch Med Wochenschr 1997; 122(14): 432–438.

9. Hong JJ, Park W, Ehrenpreis ED. Review article: current therapeutic options for radiation proctopathy. Aliment Pharmacol Ther 2001; 15(9): 1253–1262.

10. Cotti G, Seid V, Araujo S et al. Conservative therapies for hemorrhagic radiation proctitis: a review. Revista do Hospital das Clinicas 2003; 58(5): 284–292.

11. Kennedy M, Bruninga K, Mutlu EA et al. Successful and sustained treatment of chronic radiation proctitis with antioxidant vitamins E and C. Am J Gastroenterol 2001; 96(4): 1080–1084.

12. Tagkalidis PP, Tjandra JJ. Chronic radiation proctitis. ANZ J Surg 2001; 71(4): 230–237.

13. Dulai GS, Jensen DM, Cortina G et al. Randomized trial of argon plasma coagulation vs. multipolar elektrocoagulation for ablation of Barrett´s esophagus. Gastrointest Endosc 2005; 61(2): 232–240.

14. Chautems RC, Delgadillo X, Rubbia--Brant L et al. Formaldehyde application for haemorrhagic radiation-induced proctitis: a clinical and histological study. Colorectal Dis 2003; 5(1): 24–28.

15. Pikarsky AJ, Belin B, Efron J et al. Complications following formalin instilation in the treatment of radiation induced proctitis. Int J Colorectal Dis 2000; 15(2): 96–99.

16. Tsujinaka S, Baig MK, Gornev R et al. Formalin instilation for hemorrhagic radiation proctitis. Surg Innov 2005; 12(2): 123–128.

17. Cullen SN, Frenz M, Mee A. Treatment of haemorrhagic radiation-induced proctopathy usin small volume topical formalin instillation. Aliment Pharmacol Ther 2006; 23(11): 1575–1579.

18. Castano R, Puerta JD, Sanin E et al. Argon plasma coagulation versus aplication of 4 percent formalin for the treatment of radiation induced hemorrhagic proctitis. Gastrointest Endosc 2007; 65(5): 255.

19. Alexander TJ, Dwyer RM. Endoscopic Nd:YAG laser treatment of severe radiation injury of the lower gastrointestinal tract: Long term follow up. Gastrointest Endosc 1988; 34(5): 407–411.

20. Canard JM, Vedrenne B. Clinical aplication of argon plasma coagulation in gastrointestinal endoscopy: Has the time come to replace the laser? Endoscopy 2001; 33(4): 353–357.

21. Zhou C, Adler DC, Becker L et al. Effective treatment of chronic radiation proctitis using radiofrequency ablation. Therap Adv Gastroenterol 2009; 2(3): 149–156.

22. Nikfarjam M, Faulx A, Laughinghouse M et al. Feasibility of Radiofrequency Ablation for the Treatment of Chronic Radiation Proctitis. Surg Innov 2010; 17(2): 92–94.

23. Záň J, Minčík I, Bestvina D. Argón plazma koagulácia – prínos v terapeutickej digestívnej endoskopii.Čes a Slov Gastroent a Hepatol 2004; 58(4): 136–140.

24. Kopáčová M, Rejchrt S, Bureš J. Využití argonové plasmakoagulace v digestivní endoskopii. In: Zavoral M, Dítě P, Špičák J et al. Nové trendy v digestivní endoskopické diagnostice a léčbě. Praha: Grada 2000: 255–275.

25. Wilson SA, Rex DK. Endoscopic treatment of chronic radiation proctopathy (Review). Curr Opin Gastroenterol 2006; 22(5): 536–540.

26. Venkatesh KS, Ramanujam P. Endoscopic therapy for radiation proctitis-induced hemorrhage in patients with prostatic carcinoma using Argon Plasma Coagulator application. Surg Endosc 2002; 16(4): 707–710.

27. Zinicola R, Rutter MD, Falasco G et al. Haemorrhagic radiation proctitis: endoscopic severity may be useful to guide therapy. Int J Colorectal Dis 2003; 18(5): 439–444.

28. Silva RA, Correia AJ, Dias LM et al. Argon plasma coagulation therapy for hemorragic radiation proctosigmoiditis. Gastrointest Endosc 1999; 50(2): 221–224.

29. Fantin AC, Binek J, Suter WR et al. Argon beam coagulation for treatment of symptomatic radiation-induced proctitis. Gastrointest Endosc 1999; 49 (4 Pt 1): 515–519.

30. Kaasis M, Oberi F, Burtin P et al. Argon plasma coagulation for the treatment of hemorrhagic radiation proctitis. Endoscopy 2000; 32(9): 673–676.

31. Tam W, Moore J, Schoeman M. Treatment of radiation proctitis with argon plasma coagulation. Endoscopy 2000; 32(9): 667–672.

32. Villavicencio RT, Rex DK, Rahmani E. Efficacy and complications of argon plasma coagulation for hematochezia related to radiation proctopathy. Gastrointest Endosc 2002; 55(1): 70–74.

33. Canard JM, Vedrenne M, Bors G et al. Résultats á long terme du traitement des rectites hémorrhagiques par la coagulation au plama d´argon (full text in English on www.e2.med.com/gcb). Gastroenterol Clin Biol 2003; 27(5): 455–459.

34. Gheorghe C, Gheorghe L, Iacob S et al. Argon plasma coagulation for radiation proctitis. Rom J Gastroenterol 2003; 12(2): 107–112.

35. Ravizza D, Fiori G, Trovato C et al. Frequency and outcomes of rectal ulcers during argonplasma coagulation for chronic radiation-induced proctopathy. Gastrointest Endosc 2003; 57(4): 519–525.

36. Higuera SC, Arribas MM, Gomes RS et al. Efficacy and safety of argon plasma coagulation for the treatment of hemorrhagic radiation proctitis. Rev Esp Enferm Dig 2004; 96(11): 758–764.

37. Ben-Soussan E, Antonietti M, Savoye G et al. Argon plasma coagulation in the treatment of hemorrhagic radiation proctitis is efficient but requires perfect colonic cleansing to be safe. Eur J Gastroenterol Hepatol 2004; 16(12): 1315–1318.

38. Sebastian S, O´Connor H, O´Morain C et al. Argon plasma coagulation as fist-line for chronic radiation proctopathy. J Gastroenterol Hepatol 2004; 19(10): 1169–1173.

39. Dees J, Meijseen MA, Kuipers EJ. Argon plasma coagulation for radiation proctitis. Scand J Gastroenterol 2006; Suppl 243: 175–178.

40. Chino A, Uragami N, Hosaka H et al. Therapeutic strategy for hemorrhagic radiation proctitis – the optimum condition of argon plasma coagulation (APC) (abstract). The Japanese journal of gastroenterology 2005; 102(11): 1405–1411.

41. Andrejev HJ. Letters to the editor. To: Posgate et al.: Argon plasma coagulation in chronic radiation proctitis. Endoscopy 2007; 39(8): 751–752.

42. Chutkan R, Lipp A, Waye J. The argon plasma coagulator: a new and effective modality for treatment of radiation proctitis (abstract) Gastrointest Endosc 1997; 45: AB27.