Chronic radiation proctitis is an infrequent complication of pelvic radiotherapy,
occurring in 5 % – 20 % of patients [1]. Argon plasma coagulation (APC) is the preferred endoscopic therapy for treatment
of chronic radiation proctitis and is considered effective and well tolerated.
A 74-year-old man with a history of radical prostatectomy and subsequent radiotherapy
3 years previously was brought to the emergency room of our center because of proctorrhagia
for 3 days.
The patient underwent colonoscopy, which showed sigmoid diverticular disease and chronic
hemorrhagic radiation proctitis involving the distal 4 cm of the rectum. The patient
underwent two treatments with APC separated from each other by 20 days. These resulted
in the creation of a large ulcer that involved one-third of the wall, but no clinical
improvement ([Fig. 1 a]). In view of the absence of improvement and continued episodes of proctorrhagia,
the large extent of the disease, and the possibility that at least five more APC treatments
would be needed, we decided to treat the patient with rectal band ligation (RBL) instead.
Fig. 1 Appearances during lower gastrointestinal endoscopy showing: a the area of chronic hemorrhagic radiation proctitis after argon plasma coagulation
(APC) therapy; b rectal band ligation (RBL) being performed; c complete resolution of the chronic hemorrhagic radiation proctitis after the two
RBL procedures.
RBL was performed with a standard gastroscope and a standard endoscopic esophageal
variceal ligation kit in two procedures separated by a period of 20 days. The patient
was not sedated during the procedures. Three bands were placed in the first session
and two during the second session ([Fig. 1 b]). RBL was well tolerated: the patient reported no pain during the procedures or
in the subsequent days. Throughout the treatment period the patient underwent topical
therapy with mesalazine. A lower gastrointestinal endoscopy 45 days after the completion
of treatment showed no evidence of ongoing chronic hemorrhagic radiation proctitis
([Fig. 1 c]) and the topical therapy was discontinued.
To date there are no data or reports in the literature regarding the use of band ligation
for the treatment of chronic hemorrhagic radiation proctitis. In our experience, RBL
is an effective, painless, safe, and rapid treatment for this disease, which we believe
could be used as the first approach in extensive chronic hemorrhagic radiation proctitis.
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