Published online Apr 7, 2019. doi: 10.3748/wjg.v25.i13.1618
Peer-review started: January 28, 2019
First decision: February 13, 2019
Revised: February 20, 2019
Accepted: February 22, 2019
Article in press: February 23, 2019
Published online: April 7, 2019
Radiotherapy is widely used in the treatment of pelvic malignancies. Hemorrhagic chronic radiation proctitis (CRP) is one of the most concerning complication that occurs in 1%-5% of patients who received pelvic radiotherapy for cancer. Current treatment modalities for hemorrhagic CRP include three main categories: medical, interventional, and surgical. Although a wide range of therapeutic modalities are available, there is no literature to date showing any particularly appropriate therapeutic modality for each disease stage.
Argon plasma coagulation (APC) is currently recommended as the first-choice treatment for hemorrhagic CRP, due to its coagulation depth control, easy accessibility, relatively high effectiveness, and low cost. However, its indication based on long-term follow-up is still unclear.
This study aimed to review the long-term efficacy and safety of APC for hemorrhagic CRP, and to evaluate the prognostic and risk factors.
We retrospectively analyzed demographics, clinical and endoscopic characteristics, and long-term outcomes of consecutive patients who had received APC treatment for hemorrhagic CRP from January 2013 to October 2017. Success was defined as either cessation of bleeding or only occasional traces of bloody stools with no further treatments for at least 12 mo after the last APC treatment.
This study enrolled 45 patients with a median 24-mo follow-up period (range: 12-67 mo), 33.3% of whom required blood transfusion before APC. The success rate was 68.9%, with the mean number of APC sessions being 1.3 (1-3). This study showed that telangiectasias present on more than 50% of the surface area [odds ratio (OR) = 6.53, 95% confidence interval (CI): 1.09-39.19, P = 0.04] and ulcerated area greater than 1 cm2 (OR = 8.15, 95%CI: 1.63-40.88, P = 0.01) were poor prognostic indicators for APC treatment of hemorrhagic CRP. Six (13.3%) patients had severe complications involving rectal fistulation. The only risk factor for severe complications was ulcerated area greater than 1 cm2 (P = 0.035). Further large-cohort prospective studies are required to confirm our findings.
Endoscopic severity could predict the success of APC. The long-term efficacy of APC for hemorrhagic CRP is uncertain in patients with telangiectasias present on more than 50% of the surface area and ulcerated area greater than 1 cm2. APC is not a "risk-free" treatment modality. Ulcerated area greater than 1 cm2 is also a risk factor for severe complications.
Although APC is currently recommended as the first-choice treatment for hemorrhagic CRP, its long-term efficacy and safety are still not well understood. Our study showed that endoscopic characteristics could predict the success and severe complications of APC. Prospective, multicenter, large-scale studies involving different APC settings ought to be conducted in the follow-up research.