Treatment of radiation proctitis with argon plasma coagulation

Radiation proctitis is a troublesome complication of pelvic irradiation for malignancy. One common and occasionally serious complication is rectal bleeding. Therapeutic options for this condition are limited. This study was undertaken to evaluate the usefulness of argon plasma coagulation (APC) in the treatment of rectal bleeding due to radiation proctitis.

Fifteen patients referred for treatment of rectal bleeding due to radiation proctitis were offered APC during flexible sigmoidoscopy. Data were collected retrospectively to assess patients' response to treatment. Patients were asked to score overall well-being, bleeding, fecal urgency, incontinence, and stool frequency. Transfusion requirements and nadir hemoglobin before and after treatment were also recorded. Matched data were assessed using the Wilcoxon signed-rank test.

Rectal bleeding improved significantly after treatment with APC (median pre-treatment score = 3, median post-treatment score = 1; P<0.001). Transfusion requirements ceased in three patients who had previously been anemic. Hemoglobin levels increased from a mean of 108 g/l to 133 g/l in 13 patients. In addition, other parameters of bowel function, including urgency, incontinence, and stool frequency, improved significantly after treatment. Two patients developed rectal strictures after therapy, but these were asymptomatic and treated with rectal dilation. No other complications were observed.

APC improved patient well-being and significantly reduced rectal bleeding in patients with radiation proctitis. Transfusion requirements were also reduced. APC is useful and safe in patients in whom radiation proctitis is refractory to other treatments.