4471 Argon plasma coagulation therapy for management of refractory hemorrhagic radiation proctitis.

Background : Chronic radiation proctitis, a well described complication of pelvic radiation therapy, can result in severe bleeding refractory to conventional treatment. Argon plasma coagulation, a new method of noncontact electrocoagulation, is an effective treatment for hemorrhagic lesions of the gastro-intestinal tract. Aim : To assess the efficacy and safety of argon plasma coagulation in the manangement of severe radiation proctitis resistant to medical treatment. Patients and Methods : Eleven patients (10 men, 1 female, mean age : 69 years +/- 16) with chronic radiation proctitis after radiotherapy for prostate (n=9), uterine (n=1)or rectal (n=1) cancer were enrolled in this prospective study. All had failed traditional therapies including topical steroids, 5ASA, sucralfate and formalin and even Nd YAG laser in 1 patient. All had active bleeding from diffuse telangiectasias responsible for chronic anemia and requiring blood transfusions in 7 of them. Argon flow and electrical power were set at 0.8 to 2L/min and 50 W. Each coagulation session, performed usually without anesthesia, lasted 20 min. The goal was to coagulate all visible telangiectasias, which required one to five sessions (mean 3). The mean follow-up was 13.2 months (3-25). Results: Rectal bleeding disappeared in 9 patients and was markedly reduced in 1 patient. One old patient did not complete the treatment because of intolerance to rectal preparation performed prior to coagulation sessions and its rectal bleeding continued requiring iterative tranfusions. Thus, 6 out of 7 patients who needeed blood supply had been free of transfusions during the follow-up period (average 13.2 months). The mean hemoglobin level was 7,6g/dl +/- 1,6 at the first session and increased up to 10,9g/dl +/-1,7 at the last session, and then was maintained at this level. A rectal stenosis appeared 11 months after the first session in the patient who received five sessions. Conclusion : Argon plasma coagulation is a simple, inexpensive and effective treatment for severe refractory radiation proctitis. Supervision continues to evaluate the long term benefits and risks of rectal stenosis.