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THE ROLE OF ARGON PLASMA COAGULATION (APC) IN THE TREATMENT OF CHRONIC RADIATION PROCTITIS
P Nel, A Faris, Y Su, R Sy
Department of Gastroenterology, University of Ottawa, Ontario
Radiation proctitis is a common complication of radiation treatment for pelvic malignancies. Approximately 5 to 20 % of patients who receive radiation treatment will develop chronic complications including bleeding, fistulae and stictures. To date there are no standard recommendations for the treatment of the chronic blood loss from radiation proctitis. Studied treatments, including hyperbaric oxygen, formaldehyde, 5-ASA have had varied results. Endoscopic treatment is gaining popularity in the treatment of radiation proctitis with both APC and bipolar heater probe being studied. A number of case reports suggest APC may be useful and safe in the treatment of chronic radiation proctitis. However none have utilized a validated scoring system for treatment effect.
We plan to study both the endoscopic and the clinical response of APC in the treatment of rectal bleeding from radiation proctitis.
METHOD: Patients referred from radiation oncology with chronic blood loss from suspected radiation proctitis were approached for consent to participate in this study. The patients baseline rectal bleeding was scored using a five point bleeding scale; the patient then underwent a colonoscopy to confirm the source of bleeding. The severity of radiation proctitis was scored using a validated scoring system – the rectal telangiectasia density grading score (RTG). Patients were then treated with APC and then re-evaluated in 8 weeks time. At this time, baseline bleeding score was obtained and RTG score evaluated with sigmoidoscopy. If further treatment was required the patient was again re-evaluated in 8 weeks time.
RESULTS: There were 19 patients enrolled in this study. Mean age was 72.1 (STD=8.0) and mean Hb is 134.2 (STD=21.7). Three of them did not complete the study. Among the 16 patients who underwent the APC treatment, both the clinical bleeding score and RTG score were reduced after the treatment. The bleeding score reduced 0.93±1.34 (Mean ±STD), while the RTG score reduced 0.81±0.98 (Mean ±STD). The p-values for comparing the pre and post treatment bleeding and RTG scores were 0.02 and <0.01 (Wilcoxon signed ranked test) respectively.
CONCLUSION: In this small prospective trial, APC treatment for radiation proctitis improves the clinical bleeding score and the endoscopic outcomes.