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Argon plasma coagulation in the treatment of hemorrhagic radiation proctitis is efficient but requires a perfect colonic cleansing to be safe

Ben-Soussan, E; Antonietti, M; Savoye, G; Herve, S; Ducrotté, P; Lerebours, E

European Journal of Gastroenterology & Hepatology: December 2004 - Volume 16 - Issue 12 - pp 1315-1318
Original Articles: Proctitis, perianal fistula

Aims: We evaluate prospectively effectiveness, tolerance, predictive factors of failure and complications of argon plasma coagulation (APC) in the treatment of hemorrhagic radiation proctitis (HRP).

Patients and methods: Twenty-seven patients were treated by APC for HRP. Eight patients needed blood transfusion before APC. Six patients were anti-coagulated and one had severe thrombocytopenia. APC was performed without sedation in 25/27 patients. Before APC treatment, bowel preparation was performed by enema (n = 19 sessions), polyethylene glycol or sodium phosphate (n = 53 sessions). APC treatment was performed every 5 weeks. Effectiveness of APC was based on clinical and endoscopic score and biological status before and after APC treatment.

Results: The mean follow-up was 13.6 months (range, 3–31 months). After one to seven sessions of APC (average, 2.66 sessions), twenty-five patients (92%) had no recurrence of bleeding. The bleeding score decreased from 3.03 to 0.42 (P < 0.001) and the endoscopic score from 3.08 to 0.73 (P < 0.001). Out of the eight patients requiring blood transfusion prior to APC sessions, only one required blood transfusion after APC (P < 0.05). One late relapse was observed and successfully re-treated by APC. Side effects were anal or rectal pain (n = 3) and vagal symptoms (n = 2). Three colonic explosions occurred, with perforation leading to surgery in one case. The incidence of bowel explosion was higher after local preparation (3/19 sessions) compared with oral preparation (0/53 sessions) (P < 0.05). No stricture due to APC appeared, even if telangiectasias coagulated during a session were circumferential.

Conclusion: Coagulation by APC is an effective and safe treatment of HRP if a complete cleansing preparation is performed to avoid explosion.

Department of Gastroenterology, Rouen University Hospital Charles Nicolle, Rouen, France.

Correspondence and requests for reprints to Dr Emmanuel Ben-Soussan, Rouen University Hospital Charles Nicolle, Department of Gastroenterology, 1 rue de Germont, 76031 Rouen Cedex, France. Tel: +33 2 32 88 81 01; fax: +33 2 35 15 16 23; e-mail: Emmanuel.Ben-soussan@chu-rouen.fr

Received 7 January 2004 Revised 28 June 2004 Accepted 20 July 2004

© 2004 Lippincott Williams & Wilkins, Inc.