Published online Feb 27, 2016. doi: 10.4240/wjgs.v8.i2.151
Peer-review started: July 11, 2015
First decision: August 16, 2015
Revised: November 20, 2015
Accepted: December 13, 2015
Article in press: December 14, 2015
Published online: February 27, 2016
Chronic radiation proctopathy (CRP) is a troublesome complication of pelvic radiotherapy. The most common presentation is rectal bleeding. CRP symptoms interfere with daily activities and decrease quality of life. Rectal bleeding management in patients with CRP represents a conundrum for practitioners. Medical therapy is ineffective in general and surgical approach has a high morbid-mortality. Endoscopy has a role in the diagnosis, staging and treatment of this disease. Currently available endoscopic modalities are formalin, potassium titanyl phosphate laser, neodymium:yttrium-aluminum-garnet laser, argon laser, bipolar electrocoagulation (BiCAP), heater probe, band ligation, cryotherapy, radiofrequency ablation and argon plasma coagulation (APC). Among these options, APC is the most promising.
Core tip: The objective of this review is to critically analyze the available data and our experience with this disease, with suggestions for daily practice and further research. In our view, laser treatment is an obsolete technology and can be abandoned. The bipolar probe (BiCAP) is very well indicated for patients with implantable electronic devices. The best way to use formalin is still unknown. More studies with band ligation, cryotherapy and radiofrequency ablation are still needed. Argon plasma coagulation has emerged as the front-runner, due to its ease of use, affordability, better-defined settings, effectiveness and low risk of complications.