Radiofrequency ablation: a novel and effective treatment of severe bleeding secondary to actinic proctitis

Abstract

Male, 75-years-old. Cirrhosis and secondary thrombocytopenia. Eight months after radiation therapy for prostate adenocarcinoma, he presented actinic proctitis (AP) with severe rectal bleeding (haemoglobin 6.6 g/dL, platelets 28.000/mm). After five sessions of APC and sucralfato, haemostasis was not achieved producing iatrogenic rectal ulcers (Fig. 1). He received 15 red blood cell packs and 2 platelets pools. Ablation of the rectal mucosa with radiofrequency, Halo 60o system, was proposed. Using a gastroscope at whose end was inserted the radiofrequency device, and with patient under propofol sedation, we applied power of 12 J/cm and a density of 40 w, twice per area, with direct and retroverted view (Figs. 2 and 3). Only half the circumference was treated, to avoid stenosis, and also avoiding anorectal line. The patient’s tolerance was very good. After the first session control of bleeding was achieved. A second session was scheduled at 4 weeks, but because of an intercurrent neurological process, was delayed at 7 weeks, and untreated mucosa ablation was performed. The third session, four weeks later, addressed residual PICTURES IN DIGESTIVE PATHOLOGY