Therapeutic strategy for hemorrhagic radiation proctitis -the optimum condition of argon plasma coagulation (APC)

Abstract

[Aim] This study was performed to clarify the optimum condition of argon plasma coagulation (APC) to treat hemorrhagic radiation proctitis. [Subjects] Among 25 patients with hemorrhagic radiation proctitis treated in the Cancer Institute Hospital between December 2000 and May 2004, 18 were followed-up for more than 6 months. The clinical courses of these 18 patients were analyzed retrospectively. [Methods] Proctoscopic findings of the hemorrhagic lesions were categorized as type-A (localized dilated veins, n=6), type-B (diffuse dilated veins, n=6), and type-C (dilated veins associated with ulcers orerosions, n=6). APC was applied for 5-10 seconds with the power of 40 W and the argon flow of 1.0 l/min (high power APC), or for 1-2 seconds with the power of 40 W and the argon flow of 0.6 l/min (low power APC). [Results] Type-A and B patients were successfully treated with either low or high power APC without any serious complications. But some type-C patients treated with high power APC showed serious complications such as procto-vaginal fistula or prolonged ulceration. No recurrence patients were 89% (16/18) during the mean follow up period of 18±9.9 months. [Conclusion] APC therapy for hemorrhagic radiation-proctitis was useful, but the pathologic healing process and consequence were different by rectal mucosal weakness. It is necessary for the therapeutic strategy to be put up and down according to proctoscopic findings. As for the optimum condision APC short cauterization by low power setting was more recommended.