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Chronic radiation proctitis.

P P Tagkalidis¹, J J Tjandra

¹Department of Gastroenterology, Royal Melbourne Hospital, Victoria, Australia.

ANZ Journal of Surgery

|May 18, 2001

Summary

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Chronic radiation proctitis, often causing rectal bleeding after pelvic radiation therapy, is best treated initially with endoscopic therapies like argon plasma coagulation. Surgery is reserved for severe, resistant cases.

Area of Science:

Gastroenterology
Radiation Oncology

Background:

Pelvic radiation therapy for malignancy is increasingly used, leading to a rise in chronic radiation proctitis.
Rectal bleeding is the most common symptom of chronic radiation proctitis.

Purpose of the Study:

To review the pathology, clinical presentations, and assessment principles of radiation-induced proctitis.
To summarize current treatment options, including novel endoscopic therapies and surgical management.

Main Methods:

A comprehensive MEDLINE search was conducted to identify relevant literature on radiation proctitis.

Main Results:

The natural history of radiation proctitis is not well-documented; milder forms may improve, while severe forms often persist.

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Pathological features are summarized, comparing chronic to acute radiation proctitis.

Current treatment strategies, including endoscopic and surgical approaches, are reviewed.

Conclusions:

Endoscopic therapies, such as argon plasma coagulation or topical formalin, are recommended as initial treatments for problematic rectal bleeding.
Surgery is a last resort for rectal bleeding refractory to endoscopic treatment and for managing complications like strictures and fistulas.