Argon plasma coagulation in the treatment of post-radiotherapy rectal bleeding

Introduction: Chronic radiation proctitis is often associated to radiotherapy for treatment of pelvic cancer. The most common side effect of this pathological condition is rectal bleeding but despite the great number of clinical approaches and techniques that have been employed no consensus for the management of it is available. Although prospective randomized trials about hemorrhagic radiation proctitis are still lacking, endoscopic approach delivering an Argon Plasma Coagulation (APC) seems to be a successful and available option. Patients and Methods: Sixteen patients suffering from post-radiotherapy rectal bleeding were followed. In the nine cases presenting a rectum ulcerative colitis (RUC) like endoscopic picture a 5-ASA therapeutic approach was chosen initially, followed by an APC treatment of areas of telangectasias. The other cases, presenting only areas of telangectasias, were treated only with APC. Results: 5-ASA therapy led to an improvement of inflammation state related to RUC but recurrence of rectal bleeding caused by telangectasias was observed. In these cases an additional APC treatment gave a total remission of the problem. Also in the other cases, presenting only areas of telangectasias, a remission of rectal bleeding was achieved through APC application. Conclusions: In the cases of radiation proctitis characterized by a severe compromission of rectal mucosa integrity an anti-inflammatory pharmacological therapy is necessary but not sufficient to abrogate rectal bleeding which is often caused by the presence of areas of telangectasias. In these cases a remission of the problem could be achieved through a combination of anti-inflammatory therapy (5-ASA) and APC.