Argon plasma coagulation therapy for hemorrhagic radiation proctosigmoiditis

• Published in: Gastrointestinal endoscopy 1999-08, Vol.50 (2), p.221-224
• Main Authors: Silva, Rui A., Correia, António J., Dias, Luís Moreira, Viana, Helena Lomba, Viana, Rafael Lomba
• Format: Article
• Language: English
• Subjects: Adult; Aged; Argon; Biological and medical sciences; Diseases of the digestive system; Electrocoagulation - instrumentation; Endoscopes; Equipment Design; Female; Gastrointestinal Hemorrhage - pathology; Gastrointestinal Hemorrhage - surgery; Hemostatic Techniques - instrumentation; Humans; Male; Medical sciences; Middle Aged; Pelvic Neoplasms - radiotherapy; Pilot Projects; Proctocolitis - pathology; Proctocolitis - surgery; Radiation Injuries - pathology; Radiation Injuries - surgery; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Sigmoid Diseases - pathology; Sigmoid Diseases - surgery; Sigmoidoscopes; Treatment Outcome
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/S0016-5107(99)70228-2

Background: Radiation-induced proctosigmoiditis is a serious complication of pelvic radiation therapy. Rectal bleeding occurs among 6% to 8% of these patients and is extremely difficult to manage. Pharmacotherapy is generally ineffective, whereas surgical treatment is associated with high morbidity and mortality. Argon plasma coagulation is a new method of noncontact electrocoagulation well suited for hemostasis of large bleeding areas. Methods: From December 1996 through March 1998, we used argon plasma coagulation to treat 28 patients with hemorrhagic radiation-induced proctosigmoiditis. Indications for treatment were anemia (n = 18) and persistent bleeding despite pharmacotherapy (n = 10). Argon flow and electrical power were set at 1.5 L/min and 50 W. The severity of rectal bleeding was graded from 0 to 4 (highest), and hemoglobin levels were recorded before and after treatment. Results: Eighty-two therapeutic sessions were performed (median 2.9 sessions per patient). The severity score for rectal bleeding dropped at least 1 point for all but 2 patients, and the mean value decreased from 2.96 to 0.68. Average hemoglobin level increased 1.2 gm/dL (1.9 gm/dL among anemic patients). No serious complications were observed. Conclusions: Argon plasma coagulation appears to be a simple, safe, and effective technique in the management of hemorrhagic radiation-induced proctosigmoiditis. (Gastrointest Endosc 1999;50:221-4.)