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Subject Area

Endemic and Tropical Medicine

Article Type

Original Study

Abstract

Background Radiation proctitis is a pelvic radiation-induced complication that leads to endothelial dysfunction and neovascular lesions. Recently, argon plasma coagulation (APC) is an innovative electrocoagulation technique for treatment of hemorrhagic radiation proctitis. Aims To study the efficacy and safety of APC for the treatment of pelvic radiotherapy-induced rectal angiodysplasias. Patients and methods A prospective study on 50 patients complaining of post-pelvic radiation rectal angiodysplasias was conducted. Colonoscopy was done initially for all patients to detect presence of mucosal vascular complications and then at 1 and 6 months later to follow-up the degree of response, efficacy, and safety of the treatment. According to colonoscopic findings, patients were classified into three groups: group I included 16 patients who had angiodysplasias associated with bleeding per rectum, group II included 16 patients with angiodysplasias without bleeding per rectum, and group III included 18 patients who had no angiodysplasias. Patients who had angiodysplasia with evidence of bleeding or not have been treated by APC (ERPE VIO 200D) with power of 40 W, interval of 2 s, and flow rate of 1.5–2 l/min. Results The mean age was 59.3 years, and 78.1% were males. Last radiotherapy session was 9.53 months ago. Prostate cancer constituted 62.5% of the studied patients. APC was successful in reducing clinical symptoms in 16 (100%) patients with angiodysplasia and healed mucosa after single APC session in group II, and 14/16 in group I has improved clinical picture and healed rectal mucosa during follow-up periods. In group I, 31.3, 62.5, and 6.3% of patients required single, two, and three sessions, respectively. However, 93.8% of patients in group II achieved treatment success after only a single session. The mean number of sessions was significantly higher in group I than group II (1.75 ± 0.57 vs. 1.06 ± 0.25, respectively; P = 0.001). APC-induced adverse events were minimal with only two (6.3%) patients having abdominal pain and three (9.3%) patients had distension. Conclusion APC is an effective and safe procedure with minor adverse effects for treatment of hemorrhagic radiation proctitis.

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