Efficacy and Safety of Endoscopic Treatment for Chronic Hemorrhagic Radiation Enteropathy: A Systematic Review and...

Chronic hemorrhagic radiation enteropathy, a common complication secondary to pelvic radiotherapy, can be treated by endoscopy. However, the efficacy and safety of endoscopic treatment have not been systematically assessed.

PubMed, EMBASE, and Cochrane Library databases were searched to identify all relevant studies on endoscopic treatment for chronic hemorrhagic radiation enteropathy. A random-effects model was employed to perform meta-analyses. Pooled rates and weighted mean difference were calculated. Heterogeneity was explored through meta-regression, leave-one-out sensitivity, and subgroup analyses.

Overall, 81 studies including 2626 patients with chronic hemorrhagic radiation enteropathy were eligible. Among them, argon plasma coagulation (APC) was performed in 2255 patients, with the rates of clinical success, endoscopic success, transfusion-free, recurrence, mild and moderate adverse events, and serious adverse events being 95%, 97%, 100%, 7%, 7%, and 0%, respectively; and the mean hemoglobin level increased by 20.61 g/L. Radiofrequency ablation was performed in 132 patients, with the rates of clinical success, endoscopic success, transfusion-free, recurrence, mild and moderate adverse events, and serious adverse events being 100%, 100%, 84%, 8%, 8% and 0%, respectively; and the mean hemoglobin level increased by 20.33 g/L. After laser treatment, cryotherapy, heater probe treatment, and bipolar electrocoagulation, the clinical success rates were 87%, 92%, 100%, and 94%, respectively; and the endoscopic success rates were 91%, 89%, 100%, and 100%, respectively.

Endoscopic treatments are often effective and safe for chronic hemorrhagic radiation enteropathy. APC is the most widely studied choice of endoscopic treatment. In future, head-to-head comparative studies are needed to explore their benefits and risks.