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Argon plasma coagulation for radiation proctitis.

Jan Dees1, Maarten A C Meijssen, Ernst J Kuipers

  • 1Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands. j.dees@erasmusmc.nl

Scandinavian Journal of Gastroenterology. Supplement
|June 20, 2006
PubMed
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Argon plasma coagulation (APC) effectively treats rectal bleeding from radiation proctitis. This safe and well-tolerated procedure achieved remission in 98% of patients, though anticoagulants and aspirin may increase bleeding risk.

Area of Science:

  • Gastroenterology
  • Oncology

Background:

  • Radiation proctitis frequently causes rectal blood loss, with telangiectasias affecting 2-5% of patients post-pelvic radiotherapy.
  • Pharmacotherapy is often ineffective, necessitating local treatments like formalin irrigation, Nd:YAG laser, and argon plasma coagulation (APC).

Purpose of the Study:

  • To evaluate the safety and efficacy of argon plasma coagulation (APC) for treating rectal bleeding in patients with radiation proctitis.

Main Methods:

  • Fifty consecutive patients with radiation proctitis-induced rectal bleeding were treated with APC between January 1997 and August 2001.
  • APC was administered using a no-touch spotting technique at 50W power, 2.0 l/min argon flow, and pulse durations <0.5s, with sessions every 3 weeks.
  • Patient characteristics included anemia (13), blood transfusions (6), anticoagulant therapy (9), and low-dose aspirin use (10).

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Main Results:

  • Argon plasma coagulation (APC) achieved persistent clinical and endoscopic remission of rectal bleeding in 98% (47/48) of assessable patients after a median of three sessions.
  • No adverse effects were observed during initial treatment.
  • One patient experienced recurrent bleeding after resuming anticoagulants, and another had a serious complication (major rectal bleeding) after aspirin prescription for a transient ischemic attack.

Conclusions:

  • Argon plasma coagulation (APC) is a safe, effective, and well-tolerated treatment for radiation-induced rectal bleeding.
  • Anticoagulants and aspirin may act as co-factors that promote bleeding in patients treated with APC.