Background: Radiation colitis, an insidious, progressive disease of increasing frequency, develops 6 mo to 5 years after regional radiotherapy for malignancy, owing to the deleterious effects of the latter on the colon and the small intestine. Management of chronic radiation colitis remains a major challenge owing to the progressive evolution of the disease, including development of fibrosis, endarteritis, edema, fragility, perforation, partial obstruction, and cancer. Patients are commonly managed conservatively. Our purposes were to (1) evaluate efficacy and safety of bipolar heater probe endoscopic coagulation compared to prior medical therapy for bleeding radiation telangiectasia, and (2) consider the impact of treatments on patients' impression of their overall health and activity.Methods: Six months of medical management had failed in 2 men and 9 women with chronic, recurrent hematochezia and anemia after radiation treatment of pelvic malignancies. Patients had multiple rectal telangiectasias coagulated with bipolar heater probes CD 120 U with Olympus HPU 20 unit in a randomized, prospective study. Patients followed for 6 months.Results: Rectal bleeding stopped within four treatment sessions. During 6 months of endoscopic versus medical therapy, severe bleeding episodes diminished significantly for bipolar heater probe versus 6 months of prior medical therapy (79% vs 37%); mean hematocrits rose significantly for patients undergoing bipolar heater probe (40.2 vs 30.1) treatment, and their impression of overall health improved. During long-term follow-up, new telangiectasias or rectal bleeding were easily controlled. No major complications resulted.Conclusion: Bipolar heater probe is safe and effective relative to medical therapy for palliation of patients with lower gastrointestinal bleeding from radiation colitis, all patients improved in ability to travel and day to day working and in their overall impression of their health. Background: Radiation colitis, an insidious, progressive disease of increasing frequency, develops 6 mo to 5 years after regional radiotherapy for malignancy, owing to the deleterious effects of the latter on the colon and the small intestine. Management of chronic radiation colitis remains a major challenge owing to the progressive evolution of the disease, including development of fibrosis, endarteritis, edema, fragility, perforation, partial obstruction, and cancer. Patients are commonly managed conservatively. Our purposes were to (1) evaluate efficacy and safety of bipolar heater probe endoscopic coagulation compared to prior medical therapy for bleeding radiation telangiectasia, and (2) consider the impact of treatments on patients' impression of their overall health and activity. Methods: Six months of medical management had failed in 2 men and 9 women with chronic, recurrent hematochezia and anemia after radiation treatment of pelvic malignancies. Patients had multiple rectal telangiectasias coagulated with bipolar heater probes CD 120 U with Olympus HPU 20 unit in a randomized, prospective study. Patients followed for 6 months. Results: Rectal bleeding stopped within four treatment sessions. During 6 months of endoscopic versus medical therapy, severe bleeding episodes diminished significantly for bipolar heater probe versus 6 months of prior medical therapy (79% vs 37%); mean hematocrits rose significantly for patients undergoing bipolar heater probe (40.2 vs 30.1) treatment, and their impression of overall health improved. During long-term follow-up, new telangiectasias or rectal bleeding were easily controlled. No major complications resulted. Conclusion: Bipolar heater probe is safe and effective relative to medical therapy for palliation of patients with lower gastrointestinal bleeding from radiation colitis, all patients improved in ability to travel and day to day working and in their overall impression of their health.