Rectal Band Ligation as an Alternative Treatment for Chronic Radiation Proctitis

Aims Chronic radiation proctitis (CRP) occurs in 10-15 % of patients undergoing pelvic radiation therapy and frequently manifests with rectal bleeding, requiring blood transfusion. Endoscopic management of more severe and refractory cases of rectal hemorrhage is possible and argon plasma coagulation (APC) is currently recommended as the first-choice treatment although there is evidence of limited efficacy in cases of extensive rectal involvement. Rectal band ligation (RBL) has been shown to be a feasible alternative to APC. Our aim is to describe safety and efficacy of RBL in chronic hemorrhagic radiation proctitis.

Methods We analyzed all consecutive patients treated in our center with RBL for severe or recurrent hemorrhagic CRP. Standard protocol included mesalamine enemas for 30 days after RBL. Demographic, clinical and endoscopic aspects were recorded. Success was defined as endoscopic evidence of complete rectal healing and/or absence of bleeding recurrence with no need for further treatment.

Results We identified 10 patients (7 males, mean age 75.6 years). Median length of affected rectum from the anal verge was 4.5 cm (range 3-12) and mean surface area involved was 89 %. Eight patients (80 %) were naïve of endoscopic treatment, while 2 had undergone APC without any beneficial. Median follow-up was 136.5 days (range 21-979). Success was achieved in 100 % of patients after a mean number of 1.8 RBL sessions. A mean number of 4.7 bands were released in the first session while a mean of 3.1 and 2 bands were respectively placed in the second and third session. As for adverse events, only 1 patient reported tenesmus and pelvic pain after the procedure, with spontaneous resolution after 30 days.

Conclusions RBL is a safe and effective therapeutic modality for chronic hemorrhagic CRP. It could be considered a valid first-line option in case of extensive rectal involvement as well as a viable rescue treatment after failed APC.

Citation: Lamonaca L, Auriemma F, Paduano D etal. eP265 RECTAL BAND LIGATION AS AN ALTERNATIVE TREATMENT FOR CHRONIC RADIATION PROCTITIS. Endoscopy 2021; 53: S185.

Publication History

Article published online:
19 March 2021