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ARGON PLASMA COAGULATION FOR THE TREATMENT OF HEMORRHAGIC RADIATION SIGMOIDITIS AND PROCTITIS
MCW Lam, CKW Wong
Royal Alexandra Hospital and Cross Cancer Institute, Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta
Purpose: Radiation colitis is not an uncommon consequence of pelvic radiation, such as in patients treated for gynecologic cancers. Some of these patients may suffer from anemia requiring transfusion due to chronic bleeding. Many of these patients are managed with rectal medications, which is often inadequate for control. Argon plasma coagulation (APC) has been well described for its efficacy in treating radiation proctitis. Here, we present two cases in which APC therapy was used to treat radiation sigmoiditis.
METHODS: We followed two cases originally seen at our regional cancer centre (Cross Cancer Institute) in Edmonton, Alberta, Canada. Both patients received pelvic radiation for endometrial cancers and were referred for active bleeding secondary to radiation colitis that had required numerous transfusions.
RESULTS: Radiation induced telangiectasias were found from 10-50 cm in the sigmoid colon. Both patients had significant improvement of symptoms after one session of APC treatment set at 40-60W and gas flow of 2.0L/min. To assess the efficacy of treatment, a second endoscopy with APC was performed. There were no complications from the procedures. Neither patient require blood transfusions after the initial treatment with improvement in their hemoglobin levels and were doing well at seven and 13-month follow up.
CONCLUSION: Argon plasma coagulation can be used effectively to provide immediate and sustained resolution of symptoms in patients with radiation sigmoiditis (colitis).