Formalin irrigation for hemorrhagic chronic radiation proctitis

Area of Science:

• Gastroenterology
• Radiation Oncology
• Surgical Innovation

Background:

• Chronic radiation proctitis (CRP) causes significant rectal bleeding in cancer survivors.
• Refractory cases often require advanced treatment modalities.
• Topical formalin irrigation is a recognized, albeit sometimes aggressive, treatment option.

Purpose of the Study:

• To evaluate the safety and effectiveness of a modified topical formalin irrigation technique.
• To assess outcomes in patients with refractory hemorrhagic CRP unresponsive to prior therapies.

Main Methods:

• A cohort of 24 patients with grade II-III rectal bleeding underwent topical 4% formalin irrigation under anesthesia.
• Exclusion criteria included anorectal strictures, deep ulcerations, and fistulas.
• Patient data and endoscopic findings (Vienna Rectoscopy Score) were collected; outcomes were assessed post-procedure.

Main Results:

• The modified formalin irrigation achieved a 79.1% effectiveness rate at one month, with complete or obvious bleeding cessation in 19 patients.
• No adverse side effects were reported during the study.
• Long-term follow-up showed persistent bleeding in a decreasing proportion of patients over time; three rectovaginal fistulas were identified, associated with higher endoscopic scores.

Conclusions:

• Modified topical formalin irrigation is a safe and effective treatment for hemorrhagic chronic radiation proctitis.
• The procedure demonstrates good long-term efficacy in controlling rectal bleeding.
• Careful patient selection is recommended, particularly for those with high endoscopic Vienna Rectoscopy Scores, due to potential fistula development.