Endoscopic management of chronic radiation proctitis

Table 1 Literature on contact probe therapy use in chronic radiation proctopathy

Authors	Modality	n	No. of treatment	Power settings	Response rate	Duration of study	Side effects
Jensen et al[18], 1997	Heater probe	12	4 (mean)	10-15 W, 1 s pulses	12/12 (100%)	24/12	None
Fuentes et al[25], 1993	Heater probe	8	1-4	20 J/pulse	8/8 (100%)	N/A	None
Jensen et al[18], 1997	Bipolar	9	4 (mean)	10-15 J	9/9 (100%)	24/12	None
Haulk et al[69], 1996	Bipolar	8		2-5 W or 11-25 W	8/8 (100%)	4/12	None
Mannoury et al[22],1991	Bipolar	4		Setting 5, 2 s pulses	4/4 (100%)	9/12	None

N/A: Not available.

Table 2 Literature on neodymium:yttrium-aluminium-garnet laser therapy use in chronic radiation proctopathy

Author	n	Power settings	Mean no. of sessions	Response rate	Duration (mo)	Side effects
Ventrucci et al[29], 2001	9		3	4/9 (44% CR), 4/9 (44% PR)	N/A	None
Taylor et al[21], 2000	23	4-10 W		15/23 (65%)	6	2 rectal ulcers
Barbatzos et al[20], 1996	9	20-30 W	3	6/9 (66% PR)	24	None
Chapuis et al[70], 1996	34	40 W		30/34 (88%)	6-64	4 mucous discharge, 1 acute prostatitis, 1 rectal stricture
Lucarotti et al[11], 1991	5	80 W		5/5 (100%)	18	NA
Jacobs[71], 1989	2	NA		2/2 (100%)	12	NA
Alexander et al[72], 1988	8	80-90 W		6/8 (75%)	21	3 ileus, 1 abdominal pain
Alqhuist et al[73], 1986	4	30-40 W		2/4 (50% CR)	12	1 tenesmus
Leuchter et al[26], 1982	1	60 W	4	1/1 (100% CR)	24	None

CR: Complete remission; PR: Partial remission; NA: Not available.

Table 3 Literature on argon plasma coagulation therapy use in chronic radiation proctopathy

Study Ref.	n	Mean age (yr) (range)	Settings -flow rate- power	Mean No. of sessions per patient	Responserate	Improvement in anemia (% patients), mean increase in Hgb (gm%)	Relief of transfusion dependency	Follow-up duration mean (mo)	Complications/Side effects	% requiring transfusion
Swan et al[49], 2010	50	72.1 (51-87)	1.4-2 L/min, 50 W	1.36 (1-3)	96%	1.9 gm% mean increase		20.6 (6-48)	Short-term: 17 (34%) patients (proctalgia in 13, rectal mucous discharge in 4, incontinence in 1, fever in 1, and bleeding in 1); long-term: 1 (2%) asymptomatic rectal stricture
Karamanolis et al[46], 2009	56	68.4 (45–86)	2.0 L/min, 40W	2 (1-8)	Mild (100%), severe (79%), total (89%)	N/A	7/9	17.9 (6-33)	one case of colonic explosion without perforation; No strictures or persistent ulcers; 2 on anticoagulation with recurrence	9/56 (16%)
Tormo et al[74], 2009	22	74.3	2 L/min, 50 W	2.58 (1-7), median-2	100%	N/A	N/A	N/A	None	2/22 (9%)
Alfadhli et al[14], 2008	14	74.7	1.2-2 L/min, 45-50 W	1.78	78.5%	2 gm% mean increase	N/A	3	2/14 (33.3%) mild	N/A
Latorre et al[75], 2008	38	70.9		3.6 ± 2.7		mean2.7 gm% mean increase		28
Dees et al[76],2006	48		2 L/min, 50 W	Median-3	98%				Two patients-recurrent blood loss on anticoagulation; 1-ulcer	6/48 (12.5%)
Ben-Soussan et al[53], 2004	27	73.1 (53-86)	0.8-1.0 L/min, 40-50 W	2.66 (1-7)	92%			13.6 (3-31)	Side effects-anal/rectal pain (n = 3), vagal symptoms (n = 2), 3 colonic explosions-1 with perforation requiring surgery, no stricture	8/27 (30%)
Higuera et al[77], 2004	10		1.5-2.0 L/min, 60 W	1.9 (1-4), median (2)	100%	1.5-1.9 gm% mean increase	1/1 (100%)	31.1 (10-45)	No ulcers/strictures, 1 (10%)-tenesmus
Sebastian et al[39], 2004	25	69 (53–77)	1.5 L/min, 30 W (25-40 W)	median-1	21/25 (76%, 81% or 84%??)	2.4 gm% mean increase		Median 14-	1-rectal pain
Urban et al[78], 2004	8			1-4	100%
Ravizza et al[51], 2003	27	72 (62-83)	3 L/min + 60 W (n = 17) reduced to 2 L/min and 40 W (n = 10)	2 (1-5)	85% marked improvement, 10/27 only had minor bleeding, 48% Complete resolution	3.2 g/dL mean increase	6/6 (100%) transfusion relief	11.5 (1-24)	Short term-2/27 (7%), 1-transient anal/rectal pain, 1-fever; long-14/27 (52%)-asymptomatic rectal ulcers	6/27
Gheorghe et al[58], 2003	42		60 W (23), 50 W (19)	1.34, 1.9
Canard et al[48], 2003	30	70.7 (58-85)	0.8-2 L/min, 30-80 W	2.3 (1-5)	(87%)			20 (3-35)	Overall-47%; 3 severe (10%): 1 severe bleeding, 1 extensive necrosis of lower part of rectum, 1 perforation. 3 microrectitis and 2 asymptomatic rectal stenosis. Post-Rx pain in 6 patients (20%)	17%
Venkatesh et al[79], 2002	40	64-83	1-1.5 L/min, 40-60 W	Mean-1.35 median-1 (1-2)	97.5%	- 97.5% patients	20/21 (95.2%)	NR 3-30	1-urinary retention, 2-fever requiring antibiotics	21/40 (52.5%)
Taieb et al[80], 2001	11	73 (54-86)	0.8-2 L/min, 50W	3.2 (1-5)	82% CR, 18% PR	3.8 gm% mean increase	7/7 (100%)	19 (7-30)		7/11 (63.6%)
Tjandra et al[41], 2001	12		1.5L/min, 40 W	2 (1-3)	50% CR, 50% PR, 83% Signi	1.1 gm% mean increase	4/4 (100%)	11 (4-17)	None	4/12 (33%)
Smith et al[81], 2001	7		1.6 L/min, 40-45 W	1-3	71% CR, 29% PR			4-13	None
Rolachon et al[82], 2000	12	70.3	1.0 L/min, 50 W	Mean (2.8 ± 0.8)	66% CR, 83% PR	1.8 gm% mean increase		6	3/12 (25%), 2-chronic rectal ulcerations, 1-asymptomatic rectal stenosis
Kaassis et al[44], 2000	16	73.5 (62-80)	0.6 L/min, 40 W	Mean-3.7 (2-8)	44% CR, 56% PR		3/3 (100%)	10.7 (8-28)	No	3/16 (18.75%)
Tam et al[40], 2000	15		2 L/min, 60 W	Median-2 (1-4)	100%	2.5 gm% mean increase	3/3 (100%)	Median-24 (8-35)	2-asymptomatic rectal strictures requiring dilation	3/15 (20%)
Silva et al[45], 1999	28	65 (42-77)	1.5 L/min, 50 W	2.9 (1-8)	93%	1.2 gm% mean increase	-	10 (1-15)	No, 3-transient anal pain	15/28 (53%)
Fantin et al[62], 1999	7		3 L/min, 60 W	2 (2-4)	100%			Median 24 (18-24)	No
Chutkan et al[83], 1997	12			1	92%			6.6	No	3/12 (25%)
Villavicencio et al[50], 2002	21	Median 72.6 ( 58-86)	1.2-2.0 L/min, 45-50 W	1.7 median (1-4)	95%	100% patients	4/4 (100%)	10.5 Median (1-29)	4-rectal pain, tenesmus, diarrhea	4/21 (19%)
Rotondano et al[84], 2003	24		0.8-1.2 L/min, 40 W	Median 2.5	100%				1-RV Fistula
Zinicola et al[42], 2003	14		2 L/min, 65 W	2 (1-4)	86%%		3/3 (100%)	19 (5-41)	1-asymptomatic recto-sigmoid stenosis	3/14 (21%)