Background and study aim: Chronic radiation coloproctopathy (CRCP) is a well-recognized complication of radiotherapy,
with rectal bleeding the most common presentation. It is frequently refractory to
conservative management, but the optimal endoscopic treatment of bleeding secondary
to CRCP is still controversial. The efficacy and safety of bipolar eletrocoagulation
(BEC) and argon plasma coagulation (APC) in the management of bleeding from CRCP were
evaluated and compared.
Patients and methods: 30 patients (mean age 67.4 years) with active and chronic bleeding from telangiectasias,
were randomly allocated to BEC or APC and stratified by severity of CRCP according
to clinical severity and endoscopic findings (Saunders score). Success was defined
as eradication of all telangiectasias, and therapeutic failure as need for more than
seven sessions or for other treatment. Complications were categorized as minor (e. g.
fever, anal or abdominal pain) or major (hemorrhagic).
Results: Both treatments were equally effective for the treatment of CRCP rectal bleeding.
Only one failure was observed in each group (P = 1.000). There was no significant difference between the two groups regarding number
of sessions, minor or major complications, or relapse. However, overall complication
rate was significantly higher in the BEC group (P = 0.003).
Conclusions: BEC and APC are both effective for the therapy of bleeding telangiectasias from CRCP.
There are probably no major differences between them. Although APC seemed safer than
BEC in this investigation, further studies, involving a much larger population, are
needed to assess the complication rates and determine the best management option.
References
Luciano.lenz@terra.com.br
