Department of Medicine, VA Medical Center and University of Minnesota, Minneapolis, Minnesota, USA.
Dis Colon Rectum. 2012 Oct;55(10):1081-95. doi: 10.1097/DCR.0b013e3182587aef.
Chronic radiation proctopathy is associated with significant morbidity. The effectiveness of endoscopic and medical therapies has not been evaluated.
The aim of this study was to conduct a systematic review of the effectiveness of endoscopic and comparative medical therapies for chronic radiation proctopathy.
A comprehensive search Medline and PubMed was performed.
A comprehensive literature search was performed for studies of endoscopic and medical therapy for clinical and endoscopic improvement in chronic radiation proctopathy from January 1990 until December 2010. The quality of the overall evidence was rated according to the Grading of Recommendations, Assessment, Development, and Evaluation Working Group.
Patients in both inpatient and outpatient settings were assessed.
Patients experiencing chronic radiation proctopathy were included.
Patients had undergone medical or endoscopic treatments for chronic radiation proctopathy.
The primary outcomes measured were the resolution or improvement in symptoms.
A total of 39 studies were found, of which 27 evaluated endoscopic therapy and 12 evaluated medical therapy chronic radiation proctopathy. Overall, there is low-level evidence for the effectiveness of endoscopic therapy with argon plasma coagulation in reducing short-term (≤6 weeks) symptoms of chronic radiation proctopathy and insufficient evidence for long-term improvement. There is moderate-level evidence for the use of sucralfate enemas and low-level evidence for use of short-chain fatty acid enemas and hyperbaric oxygen. There is insufficient evidence for other agents: topical formalin, 5-aminosalicylic acid compounds, sulfasalazine, vitamin A, and pentoxifylline.
Individual authors were not contacted, and the search was limited to English language journals only.
Endoscopic treatment with argon plasma coagulation appears effective in the short-term outcome of chronic radiation proctopathy. There is a moderate level of evidence for the use of sucralfate enemas. Large, randomized, placebo-controlled studies evaluating endoscopic and medical therapies for chronic radiation proctopathy are needed.
慢性放射性直肠炎与显著的发病率相关。内镜治疗和药物治疗的效果尚未得到评估。
本研究旨在对内镜治疗和比较药物治疗慢性放射性直肠炎的有效性进行系统评价。
全面检索了 Medline 和 PubMed。
对 1990 年 1 月至 2010 年 12 月期间关于内镜和药物治疗慢性放射性直肠炎的临床和内镜改善的研究进行了全面的文献检索。根据推荐评估、制定与评估工作组的分级，对整体证据质量进行了评级。
评估了住院和门诊患者。
患有慢性放射性直肠炎的患者。
患者接受了内镜或药物治疗慢性放射性直肠炎。
主要结局指标是症状的缓解或改善。
共发现 39 项研究，其中 27 项评估了内镜治疗，12 项评估了药物治疗慢性放射性直肠炎。总体而言，氩等离子凝固术治疗慢性放射性直肠炎的有效性有低水平证据，可减轻短期（≤6 周）症状，但长期改善的证据不足。使用锶尔福灌肠剂有中等水平证据，使用短链脂肪酸灌肠剂和高压氧有低水平证据。其他药物如局部福尔马林、5-氨基水杨酸化合物、柳氮磺胺吡啶、维生素 A 和己酮可可碱的证据不足。
未联系到个别作者，且检索仅限于英文期刊。
氩等离子凝固术内镜治疗在慢性放射性直肠炎的短期结果中似乎有效。锶尔福灌肠剂的使用有中等水平证据。需要进行大型、随机、安慰剂对照研究，以评估内镜和药物治疗慢性放射性直肠炎的效果。
