Endoscopy 2007; 39(4): 361-365
DOI: 10.1055/s-2007-966284
Expert approach

© Georg Thieme Verlag KG Stuttgart · New York

Argon plasma coagulation in chronic radiation proctitis

A.  Postgate1 , B.  Saunders1 , J.  Tjandra2 , J.  Vargo3
  • 1Wolfson Unit for Endoscopy, St. Mark’s Hospital, London, UK
  • 2Epworth and Royal Melbourne Hospitals, Melbourne, Australia
  • 3Section of Therapeutic and Hepatobiliary Endoscopy, Department of Gastroenterology and Hepatology, The Cleveland Clinic Foundation, Ohio, USA
Further Information

Publication History

Publication Date:
11 April 2007 (online)

Chronic radiation proctitis is a relatively common late complication of pelvic irradiation. The main symptoms are diarrhea, urgency, tenesmus, and rectal bleeding. While mild cases may settle spontaneously over some months, severe hemorrhagic radiation proctitis may require repeated blood transfusions and is difficult to treat with medical therapy. Argon plasma coagulation (APC) is a noncontact thermal coagulation technique which can be applied endoscopically. A probe passed through the scope delivers a field of argon gas to the mucosal surface where it is ionized by a high voltage filament, resulting in superficial mucosal heating and coagulation of friable blood vessels. The technique reduces rectal bleeding in 80 % - 90 % of cases, and may improve the other troublesome symptoms of diarrhea and urgency. APC is probably less effective in very severe cases of hemorrhagic radiation proctitis; in these cases topical formalin or a combination of APC and topical formalin can be useful. Overall, APC has proved to be a safe and well tolerated technique.

References

A. Postgate, , MD 

Wolfson Unit for Endoscopy
St. Mark’s Hospital

Watford Road
London, HA1 3UJ
UK

Email: apostgate@yahoo.com