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Chronic haemorrhagic radiation proctitis: A review
Vishnu Prasad Nelamangala Ramakrishnaiah1, Srinivasan Krishnamachari1
1Vishnu Prasad Nelamangala Ramakrishnaiah, Srinivasan Krishnamachari, Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India.
World Journal of Gastrointestinal Surgery
|July 28, 2016
Summary
4% formalin is the recommended first-line treatment for chronic hemorrhagic radiation proctitis (CHRP). Argon plasma coagulation (APC) is equally effective, but formalin suits severe cases. Refractory patients may need hyperbaric oxygen or surgery.
Area of Science:
- Oncology
- Gastroenterology
- Radiation Medicine
Background:
- Chronic hemorrhagic radiation proctitis (CHRP) is a challenging complication post-pelvic radiation therapy.
- Standardized treatment protocols for CHRP are lacking, necessitating evidence-based reviews.
Purpose of the Study:
- To systematically review existing literature on CHRP treatments.
- To assess improvements in study methodologies and evidence quality compared to previous reviews.
Main Methods:
- A comprehensive literature search was conducted on PubMed/Medline and Google Scholar.
- Seventy studies, including 14 randomized controlled trials, focusing on rectal bleeding due to CHRP were selected.
Main Results:
- Methodologies of recent studies show improvement with objective assessments of symptoms, signs, and outcomes.
- Few studies have investigated the impact of CHRP treatments on patient quality of life.
Conclusions:
- 4% formalin is recommended as the first-line treatment for CHRP.
- Formalin and argon plasma coagulation (APC) demonstrate comparable efficacy, with formalin preferred for severe disease.
- Hyperbaric oxygen therapy or surgery are options for refractory cases; radio-frequency ablation requires further randomized trial investigation.
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