4483 Argon plasma coagulation is an effective and well tolerated treatment for rectal bleeding due to chronic radiation proctitis.

Abstract

The treatment of rectal bleeding due to radiation proctitis is difficult to manage. Argon Plasma Coagulation (APC) is a technique of electrocoagulation which appears to be an effective and low-cost alternative to laser therapy. Aims. Our aim was to evaluate the efficacy and tolerance of APC for treatment of bleeding radiation-induced proctitis. Patients. We retrospectively analyzed the charts of 16 patients with chronic radiation proctitis. The mean age was 73.5 years (range: 62-80). Primary tumor was a prostatic cancer (No=15) and a uterine cancer (No=1). The mean time of onset of symptoms after radiotherapy was 15 months (range: 6-36). All patients complained of intermittent or daily rectal bleeding, of whom 3 needed blood transfusions. After a first colonoscopic evaluation, the patients underwent APC therapy at 1 month intervals. Argon gas flow was set at 0.6 L/min with an electrical power of 40 Watts. Results. All patients were improved by APC and a mean of 3.7 sessions (range: 2-8) was necessary for symptoms relief. During a mean follow-up of 7 months (range: 2-21 months), rectal bleeding did not recur in 7 patients (43.7%); in the other 9 patients (56.3%), bleeding was significantly reduced to occasional and negligible spotting (1 bleeding episode per week). No patient required transfusion after treatment. Immediate tolerance was good and no long-term treatment-related complication was observed. Conclusions. APC is an effective, safe and well tolerated treatment for rectal bleeding due to chronic radiation proctitis and might be considered as a first-line therapy for radiation proctitis.