Endoscopic treatments for chronic radiation proctitis

Area of Science:

• Gastroenterology
• Oncology
• Endoscopy

Background:

• Chronic radiation proctitis is a common complication following pelvic radiation therapy for malignancies.
• Symptoms include rectal bleeding, pain, diarrhea, and tenesmus, significantly impacting patient quality of life.
• Current treatments like medical management and surgery have limitations due to ineffectiveness or high morbidity.

Purpose of the Study:

• To review and evaluate the efficacy of various endoscopic treatment options for chronic radiation proctitis.
• To compare the effectiveness of argon plasma coagulation (APC), formalin application, radiofrequency ablation, and cryoablation.

Main Methods:

• Review of existing literature on endoscopic therapies for radiation proctitis.
• Analysis of treatment outcomes, including efficacy, safety, and long-term durability.
• Categorization of treatment suitability based on disease severity (mild, moderate, severe, refractory).

Main Results:

• Argon plasma coagulation (APC) is a safe, highly effective, and long-lasting endoscopic therapy for mild to moderate radiation proctitis.
• Multiple APC sessions can reduce bleeding rates and transfusion requirements.
• Intra-rectal formalin application is suitable for severe or refractory cases.
• Radiofrequency ablation and cryoablation show promise for refractory cases in limited patient cohorts.

Conclusions:

• Endoscopic therapies, particularly APC, represent a significant advancement in managing radiation-induced proctitis.
• Treatment choice should be tailored to disease severity, with APC for milder forms and other modalities for severe or refractory conditions.
• Further research may elucidate optimal strategies for advanced or treatment-resistant radiation proctitis.