Pattarajierapan Sukit, Watthanasathitarpha Gritcharat, Thonglert Kanokphorn, Amornwichet Napapat, Alisanant Petch, Khorprasert Chonlakiet, Khomvilai Supakij
Faculty of Medicine, Surgical Endoscopy Colorectal Division, Department of Surgery, Chulalongkorn University, Bangkok, Thailand; King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.
Faculty of Medicine, Surgical Endoscopy Colorectal Division, Department of Surgery, Chulalongkorn University, Bangkok, Thailand.
Gastrointest Endosc. 2025 Jul 5. doi: 10.1016/j.gie.2025.07.001.
Argon plasma coagulation (APC) is an effective treatment for radiation-associated vascular ectasias (RAVE), but nonhealing ulceration with bleeding can occur after APC. However, the risk factors for bleeding ulceration remain poorly understood. This study aimed to identify the risk factors for bleeding ulceration after APC.
We conducted a retrospective analysis using prospectively collected data. Patients who underwent pelvic radiation and APC for RAVE at our hospital between January 2017 and December 2021 were included. Rectal dose-volume parameters were quantified using the equivalent dose in 2-Gy fractions (EQD2), with D0.5 cc, D1cc, D2cc, D5cc, and D10 cc representing the minimum dose received by the highest irradiated volumes of rectal tissue.
Of the 77 patients included, 6 (7.8%) developed bleeding ulceration after APC. Compared with patients without bleeding ulceration, those with bleeding ulceration had significantly greater Vienna Rectoscopy Scores (P = .005), median rectal EQD2 D10 cc (75.2 vs 61.7 Gy, P =.02), lower therapeutic success (50% vs 99%, P = .001), and lower improvement in hemoglobin levels (50% vs 89%, P = .035). Rectal EQD2 D10 cc had the greatest area under the curve of 0.79. The optimal cut-off point of rectal EQD2 D10 cc for predicting bleeding ulceration was 70 Gy. Multivariate analysis showed that rectal EQD2 D10 cc ≥70 Gy was associated with bleeding ulceration after APC.
Rectal EQD2 D10 cc ≥70 Gy is an independent risk factor for bleeding ulceration after APC for RAVE. In multidisciplinary management involving therapeutic radiologists, endoscopists may consider nonablative treatment instead of APC in patients with rectal EQD2 D10 cc ≥70 Gy.
氩离子凝固术（APC）是治疗放射性血管扩张症（RAVE）的有效方法，但APC术后可能会出现不愈合的溃疡并伴有出血。然而，出血性溃疡的危险因素仍知之甚少。本研究旨在确定APC术后出血性溃疡的危险因素。
我们使用前瞻性收集的数据进行了一项回顾性分析。纳入了2017年1月至2021年12月期间在我院因RAVE接受盆腔放疗和APC治疗的患者。直肠剂量体积参数采用2-Gy分次等效剂量（EQD2）进行量化，D0.5 cc、D1cc、D2cc、D5cc和D10 cc分别代表直肠组织最高照射体积所接受的最小剂量。
在纳入的77例患者中，6例（7.8%）在APC术后出现出血性溃疡。与未出现出血性溃疡的患者相比，出现出血性溃疡的患者维也纳直肠镜评分显著更高（P = 0.005），直肠EQD2 D10 cc中位数更高（75.2对61.7 Gy，P = 0.02），治疗成功率更低（50%对99%，P = 0.001），血红蛋白水平改善程度更低（50%对89%，P = 0.035）。直肠EQD2 D10 cc的曲线下面积最大，为0.79。预测出血性溃疡的直肠EQD2 D10 cc最佳截断点为70 Gy。多因素分析显示，直肠EQD2 D10 cc≥70 Gy与APC术后出血性溃疡相关。
直肠EQD2 D10 cc≥70 Gy是RAVE患者APC术后出血性溃疡的独立危险因素。在涉及治疗放射科医生的多学科管理中，对于直肠EQD2 D10 cc≥70 Gy的患者，内镜医生可考虑采用非消融治疗而非APC。
