PTH-004 Efficacy and safety of argon plasma coagulation for the treatment of radiation proctopathy

Introduction Argon plasma coagulation (APC) is probably the most commonly used endoscopic treatment utilised for rectal bleeding due to radiation proctopathy (RP) but there are concerns about its efficacy and safety Method Patients treated with APC for RP were identified from the endoscopy unit software database (Unisoft) over a 6 year period from 2011–2016. The case notes of each patient were obtained and the electronic patient record was also scrutinised in regard to symptoms, response to treatment and any complications. Results 31 patients were identified that had APC for RP (median age 72, range 49–82) with all the 27 male patients having had radiotherapy for prostate cancer. There were four women that had APC for RP, 3 having had radiotherapy for cervical cancer and one having had radiotherapy for anal cancer. 28 of the 31 patients were referred for lower GI endoscopy primarily because of rectal bleeding. The number of APC treatments ranged from 1 to 7 (see figure 1) but only 10/31 (32%) required more than 3 sessions. Rectal bleeding was documented to have resolved in 28/31. In 2 patients it was unclear if rectal bleeding had resolved but the endoscopy report stated for both patients that there were only minimal RP changes and there was no need for further APC. One patient did have some persistent minor rectal bleeding but this was not thought to relate to the residual RP and APC was not given. There was only one minor endoscopic complication with small rectal ulcers noted after APC but this was not symptomatic and resolved spontaneously by the time of repeat endoscopy. APC was provided at a flow rate of 0.6L/min and a power setting of 30W for all patients. Conclusions This long-term retrospective study has shown that only 10/31 (32%) patients required more than 3 APC sessions for symptom resolution and that treatment was efficacious with symptom resolution documented in nearly all patients. There was only one minor complication of small ulcers in the rectum after APC but this was not symptomatic and resolved spontaneously. In summary, APC is an effective and safe treatment for RP but may need multiple sessions to provide symptom resolution. APC could be considered as an alternative to medical treatments such as Sucralfate enemas.