Argon plasma coagulation for the treatment of radiation proctitis

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Radiation proctitis

Chronic rectal inflammation caused by radiation affects approximately 15% of patients who undergo pelvic radiotherapy for malignancies. The etiology is thought to be chronic mucosal ischemia as a result of fibrosis and endarteritis. Acute radiation proctitis refers to mucosal injury within three months of radiotherapy. Chronic radiation proctitis can continue from the acute phase or evolve after latent period of time (usually within two years after the treatment).

Symtomps are: diarrhea, tenesmus, rectal bleeding, anemia, strictures, proctalgia. They are often difficult to treat.

Endoscopic picture of chronic radiation proctitis is characterized by diffuse teleangiectasias.

Its medical treatment (5-acetylsalicylic acid, topical corticosteroids) is often unsatisfactory. Other treatment options are formalin and sucralfat irrigation. Endoscopic therapy ( laser therapy and argon plasma coagulation- APC) are considerd to be the most effective methods.

APC is a noncontact thermal coagulation technique in which high-frequency alternating current is delivered to the tissue through ionized argon. Safety of the procedure (low risk of perforation) is associated with a coagulation of the tissue which is only supreficial (to a depth of around 0,5 to 3mm).

APC alleviates the bleeding as well as other symptoms of mild chronic radiation proctitis. In more severe cases, multiple APC session are usually required and sometimes also other treatment modalities (surgery) are necessary.

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