Department of Gastroenterology, SPS Apollo Hospitals, Punjab, India.
Gastrointest Endosc. 2010 Mar;71(3):578-82. doi: 10.1016/j.gie.2009.10.038.
Solitary rectal ulcer syndrome (SRUS) is an uncommon disorder of evacuation. Management of bleeding ulcers is usually unsatisfactory with conventional treatments. Argon plasma coagulation (APC) has been reported in case reports to control bleeding; however, it has not been shown to result in ulcer healing.
To investigate the efficacy and safety of APC in controlling bleeding from SRUS and to study its efficacy in eventual healing of ulcers.
A randomized, controlled trial of the management of 24 consecutive patients with SRUS.
The gastroenterology unit at 2 tertiary care hospitals.
Twenty-four patients with bleeding SRUS.
Control of bleeding and endoscopic healing of SRUS.
Twenty-four patients with bleeding SRUS, whose diagnoses were based on clinical, colonoscopic, and histologic findings, were randomized to receive either standard care only (12 patients, biofeedback therapy [BT] group) or multiple sessions of APC in addition to BT (12 patients, APC group). All patients were advised to intake a high level of fluids and fibers, laxatives, biofeedback, and behavior modification therapy in addition to the treatment. Patients were followed to determine whether ulcers healed.
Twenty-four patients with symptoms that lasted 12.6 +/- 4.8 months were included. Bleeding was controlled in all 12 patients in the APC group, but only in 5 of 12 patients in BT group. We also made the following observations about healing of the ulcers: 8 of 12 patients in the APC group had complete healing of their ulcers after 4 to 8 sessions, whereas in the BT group, ulcers healed in only 2 of 12 patients.
APC controls the bleeding in patients with SRUS and also improves the healing of these ulcers.
孤立性直肠溃疡综合征（SRUS）是一种不常见的排便障碍。传统治疗方法对出血性溃疡的疗效通常不佳。氩等离子凝固（APC）已在病例报告中用于控制出血，但尚未显示其能促进溃疡愈合。
研究 APC 控制 SRUS 出血的疗效和安全性，并研究其对溃疡最终愈合的效果。
在 2 家三级保健医院的胃肠病学单位进行的 24 例连续 SRUS 患者的随机对照试验。
2 家三级保健医院的胃肠病学单位。
24 例有出血性 SRUS 的患者。
SRUS 出血的控制和内镜下愈合。
24 例有出血性 SRUS 的患者，其诊断基于临床、结肠镜和组织学发现，随机分为仅接受标准治疗（12 例，生物反馈治疗[BT]组）或在 BT 基础上加用 APC 多次治疗（12 例，APC 组）。所有患者均被建议摄入高纤维、液体、泻药、生物反馈和行为矫正治疗。随访患者以确定溃疡是否愈合。
24 例症状持续时间为 12.6±4.8 个月的患者入选。APC 组的 12 例患者的出血均得到控制，但 BT 组仅 5 例患者得到控制。我们还观察到以下溃疡愈合情况：APC 组的 12 例患者中有 8 例在 4 至 8 次治疗后溃疡完全愈合，而 BT 组只有 2 例患者的溃疡愈合。
APC 可控制 SRUS 患者的出血，并改善这些溃疡的愈合。
