Management of chronic hemorrhagic radiation proctitis

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Rectal bleeding secondary to radiation proctitis is the most dreaded complication of pelvic radiotherapy. Its management remains a perplexing problem despite the availability of multiple treatment modalities. Patients are usually managed on a “hit and miss” basis at most centers. Steroid, 5-aminosalicylic acid, short chain fatty acids and sucralfate enemas, hyperbaric oxygen therapy, and topical application of 4% formaldehyde all have been used with varying results. Surgical procedures such diversion colostomy or resection of involved segment have been proposed for refractory bleeding. Endoscopic methods are being increasingly adopted in the form of bipolar electrocoagulation, heat probe coagulation, photoablation, Nd:YAG laser and preferably argon plasma coagulation. The utility of conservative approaches remains far below desirable levels. Onset of hemorrhagic recurrence represents a major obstacle that leads to a need for repeated therapeutic sessions and sometimes invocation of radical techniques. This review discusses various treatment modalities and aims to identify their efficacy and limitations. A critical review was conducted of published reports regarding management of chronic hemorrhagic radiation proctitis (CHRP). Although there are few prospective randomized trials, enough evidence is available to conclude that argon plasma coagulation represents the current treatment of choice.

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