ENDOSCOPIC BAND LIGATION FOR THE TREATMENT OF REFRACTORY RADIATION PROCTITIS

Radiation proctitisis a known complication following radiation therapy for pelvic malignancy. The majority of cases are treated with conservative management, including endoscopic treatment.

We present a patient with a chronic radiation proctitis despite treatment with argon plasma coagulation.

Case report:

67 year-old man with a history of prostate adenocarcinoma and chronic radiation proctitis. The patient was initially treated with several sesions of argon plasma coagulation in other hospital. He maintainedrectal bleeding daily and secondary anemia requiring intravenous iron therapy.

In the colonoscopy we observed radiation proctitis over hemorrhoids in distal rectum (image 1). Due to the impossibility of a new fulguration it was decided to perform endoscopic band ligation (image 2) with no complications. Six weeks later, a control endoscopy was performed, identifying post-banding ulcers (image 3), so we postponed a new control for two months. In this colonoscopywe observed a scar tissue and petechial erythematous area on hemorrhoidal pedicle (image 4), performing a new endoscopic band ligation. In the last endoscopy, six months after the first ligation, findings were post-banding scars and slight proctitis above two hemorrhoid pedicles, performing a new ligation (image 5).

Clinically, after the first endoscopic band ligation, symptoms improved only for a week, with further deterioration due to rectal bleeding secondary to rectal ulcers.

After the second endoscopic band ligation, the patient refers clear improvement of symptoms with rectal bleeding episodes reduced to rare events and hemoglobin normalization.

Discussion:

Medical and endoscopicmanagement of chronic radiation proctitis is complex, with no evidence of an efficient therapeutic option. In this case, endoscopic band ligation as an effective treatment of chronic radiation proctitis refractory to argon plasma coagulation. It is not clear the number of sessions required to control of symptoms, but it seems a possible alternative to thermal treatments.