[Long term results of treatment of hemorrhagic radiation proctitis by argon plasma coagulation].

AIM

To assess long term results of argon plasma coagulation (APC) treatment in hemorrhagic radiation proctitis.

METHODS

Thirty patients treated with APC in 2 departments were enrolled. In 16 patients, APC was the first treatment used. A clinical scale (Chutkan) was used to assess bleeding before and after treatment. An endoscopic scale was used to assess results on mucosa appearance.

RESULTS

The mean course number was 2.3 (extremes 1-5). Bleeding score decreased from 2.67 to 0.77 (P<0.001). The success rate was 26/30 patients (87%) in an intention-to-treat analysis with 2 failures (6%), 1 patient lost for follow up and 1 patient not referred after one session. Improvement in endoscopic appearance was observed in the 13 endoscopically controlled patients with a decrease of the endoscopic score from 1.61 to 0.3 (P<0.002). The overall morbidity was 47% with 3 severe complications (10%): 1 severe bleeding, 1 extensive necrosis of lower part of the rectum and 1 perforation. We also noticed 3 microrecties and 2 symptomless rectal stenosis. With regard to tolerance, we observed post treatment pain in 6 patients (20%), easily released by usual antalgics. Complications and side effects occurred, in all patients but one, when power shot was > 45 W. Mean follow up was 20 months (3 to 35 months). Hematochezia recurred in 4 patients, but were easily treated with 1 APC course.

CONCLUSION

APC is an effective treatment of hemorrhagic radiation proctitis, with a success rate of 87%. Endoscopic improvement is usual. It seems to be possible to limit the risk of complications by using low power setting.