![]() ![]() Inclusion criteria were patients who had previously undergone pelvic radiotherapy for malignant diseases including prostate, cervical, and rectal cancers and were suffering from recurrent hematochezia with or without medical treatment. Ī total of 35 patients with medical history of pelvic radiotherapy and outpatient referrals for repeated rectal bleeding were included in this study. Despite the benefits of APC, it has limited effects for severe CRP with extensive rectal surface bleeding, and the treatment may cause some major complications including perforation and extensive necrosis in 14% of patients. The coagulation depth (ranging from 0.5 mm to 3 mm) is controllable and achieves adequate hemostasis. APC provides non-contact electrocauterization with high-frequency energy conducted by ionized gas. Currently, APC is widely used and considered as the first-line endoscopic therapy for CRP. However, there is no consensus on the optimal treatment for repeated rectal bleeding in CRP. Endoscopic treatments, including argon plasma coagulation (APC) and radiofrequency ablation (RFA), are reserved for more severe or refractory patients. Generally, medical treatments are considered as first-line management, including formalin irrigation, topical steroid application, hydrocortisone enema, or hyperbaric oxygen (HBO) therapy. Īccording to disease severity, numerous treatment options are available for CRP, including medical, endoscopic, and surgical treatments. However, some patients may suffer from persistent rectal bleeding that would require repeated blood transfusion. These symptoms may resolve spontaneously or remain asymptomatic in many cases. ![]() The symptoms of CRP are similar to acute complications, including diarrhea, mucoid discharge, tenesmus, rectal pain, and rectal bleeding. In contrast to acute complications, CRP is considered a progressive condition and a significant source of morbidities. CRP results from damage to rectal epithelium, microvascular injury with intimal fibrosis, and chronic ischemia caused by radiotherapy. Chronic radiation proctitis (CRP) occurs in 5–20% of patients with more severe symptoms and is often associated with numerous complications. The symptoms of acute RP include diarrhea, anorectal pain, or rectal bleeding, and these are usually self-limiting and most resolve within two to six months. Acute RP is an inflammatory reaction to radiation and mainly occurs immediately or within the first three months after pelvic radiotherapy. RP can be acute or chronic based on the time from initiation of radiotherapy to the development of presenting symptoms. Radiation proctitis (RP) is one of the most common complications of pelvic radiotherapy. Despite the survival benefits and improved clinical outcomes associated with pelvic radiotherapy, it carries numerous side effects that would result in a decline in the patient’s quality of life. In the last few decades, pelvic radiotherapy has been used as a common treatment modality for pelvic malignancies. In conclusion, RFA treatment is safe and effective in controlling rectal bleeding in CRP without serious complications and can be considered as a first-line or alternative endoscopic treatment for patients with CRP. The rectal telangiectasia density (RTD) scores also showed significant improvement from 2.96 ± 0.2 to 0.85 ± 0.7 ( p < 0.0001). The hemoglobin (Hb) levels at 6 months after RFA revealed significant improvement from 11.0 ± 2.3 to 11.8 ± 1.9 g/dL ( p = 0.048). Mean follow-up time was 18.6 months (ranging from 2 to 52 months). Bleeding cessation was achieved in all patients. All patients sustained repeated rectal bleeding before RFA, and 15 of 35 patients needed blood transfusion. ![]() Results: 35 total patients were enrolled in the study. The patient characteristics, endoscopic findings, and clinical outcomes were collected and analyzed. Methods: We retrospectively reviewed patients who underwent RFA for CRP at Kaohsiung Chang Gung Memorial Hospital between October 2015 and March 2021. We report our clinical experience and long-term outcomes using radiofrequency ablation (RFA) in patients with CRP. Numerous treatment modalities are available to achieve hemostasis in CRP, but the optimal treatment remains controversial. Background: Chronic radiation proctitis (CRP) may develop in patients within months to years after undergoing pelvic radiotherapy. ![]()
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