Baylor College of Medicine, Michael E. Debakey Veterans Affairs Hospital, Houston, TX 77030, USA.
Gastrointest Endosc. 2011 Feb;73(2):383-9. doi: 10.1016/j.gie.2010.10.044.
Chronic radiation proctitis (CRP) is a common problem in patients receiving pelvic radiation. Current therapies have the potential for deep tissue injury with ulcerations, perforation, and fistula formation. Cryospray ablation therapy offers superficial ablation of mucosa and is a potential method to endoscopically treat CRP safely and effectively.
To determine tolerability of and response to cryotherapy in patients with radiation proctitis.
Prospective case-series pilot study.
Baylor College of Medicine, Michael E. DeBakey Medical Center, Houston, Texas.
Ten patients were prospectively recruited with chronic hemorrhagic radiation proctitis.
Endoscopic cryoablation of CRP.
Symptom severity of CRP was obtained by using the Radiation Proctitis Severity Assessment Scale (RPSAS). Endoscopic assessment was obtained using the rectal telangiectasia density grade. The primary endpoint of the study was endoscopic improvement of CRP based on the change in rectal telangiectasia density at 3-month follow-up. Secondary endpoints included symptomatic improvement based on RPSAS and adverse events at 3 months.
Ten patients with hemorrhagic radiation proctitis were treated with endoscopic cryoablation. Endoscopic severity improved as measured by rectal telangiectasia density from 2.7 to 1.7 (P=.004). Overall subjective clinical scores improved as determined by the Radiation Proctitis Severity Assessment Scale from 27.7 to 13.6 (P=.003). Endoscopic improvement correlated with symptom improvement.
Nonpowered case series pilot study.
Cryoablation improved clinical and endoscopic indices in CRP. Further controlled studies are needed to identify the safety and efficacy of cryoablation for CRP.
慢性放射性直肠炎（CRP）是接受盆腔放射治疗的患者常见的问题。目前的治疗方法有可能导致深度组织损伤，出现溃疡、穿孔和瘘管形成。冷冻喷雾消融治疗可对黏膜进行浅表消融，是一种安全有效地治疗 CRP 的内镜治疗方法。
确定冷冻治疗对放射性直肠炎患者的耐受性和反应。
前瞻性病例系列研究。
德克萨斯州休斯顿贝勒医学院迈克尔·e·德贝基医疗中心。
前瞻性招募了 10 名患有慢性出血性放射性直肠炎的患者。
CRP 的内镜冷冻消融。
采用放射性直肠炎严重程度评估量表（RPSAS）评估 CRP 的症状严重程度。采用直肠毛细血管扩张密度分级进行内镜评估。该研究的主要终点是基于 3 个月随访时直肠毛细血管扩张密度的变化，评估 CRP 的内镜改善情况。次要终点包括根据 RPSAS 评估的症状改善和 3 个月时的不良事件。
10 例出血性放射性直肠炎患者接受了内镜冷冻消融治疗。通过直肠毛细血管扩张密度从 2.7 降至 1.7（P=.004），内镜严重程度得到改善。根据放射性直肠炎严重程度评估量表，总体主观临床评分从 27.7 降至 13.6（P=.003），表明临床症状得到改善。内镜改善与症状改善相关。
非随机对照病例系列研究。
冷冻消融改善了 CRP 的临床和内镜指标。需要进一步的对照研究来确定冷冻消融治疗 CRP 的安全性和疗效。
