Radiation Proctitis and Chronic and Refractory Bleeding. Experience with 4% Formaldehyde

Abstract

IntroductionBleeding is a common complication of proctitis secondary to radiotherapy of pelvic tumors. Between 5% and 10% may become severe and refractory to topical and endoscopic treatment. Experience with the application of 4% formaldehyde is presented. Patients and methodsA retrospective and descriptive study was performed on a patient cohort with severe radiation proctitis admitted to the Hospital Universitario Donostia between January 2003 and September 2009. All patients were diagnosed by colonoscopy and admitted due to the severity of their treatment. Both 4% formaldehyde and the gauze technique were used, as well as using enemas, in cases refractory to topical and endoscopic treatment with argon. The technique was performed in theater with regional anesthetic. Clinical and endoscopic follow-up was carried out. ResultsThe study included 25 men (73.5%) and 9 women (26.5%), with a mean age of 69 years (32–80) who had rectal bleeding due to radiation proctitis and required admission. All treatments failed in 6 (28.5%) patients, and 4% formaldehyde was used, with a complete response to the bleeding in all 6 patients, with 3 cases requiring one session, and the 3 others 2 sessions. The gauze technique was used in 4 patients and another 2 were given a formaldehyde enema due to the presence of stenosis. Pain appeared as the main complication in 2 (33.3%) patients. The median follow-up was 60 months (interquartile range 26–67 months). ConclusionsThe use of 4% formaldehyde in bleeding due to radiation proctitis is an effective, easy to reproduce technique, with a low morbidity.