Chronic radiation proctopathy occurs in 5%-20% of patients following pelvic radiotherapy. Although many cases resolve spontaneously,some lead to chronic symptoms including diarrhea,tenesmus,urgency and persistent rect...Chronic radiation proctopathy occurs in 5%-20% of patients following pelvic radiotherapy. Although many cases resolve spontaneously,some lead to chronic symptoms including diarrhea,tenesmus,urgency and persistent rectal bleeding with iron deficiency anemia requiring blood transfusions. Treatments for chronic radiation proctitis remain unsatisfactory and the basis of evidence for various therapies is generally insuff icient. There are very few controlled or prospective trials,and comparisons between therapies are limited because of different evaluation methods. Medical treatments,including formalin,topical sucralfate,5-amino salicylic acid enemas,and short chain fatty acids have been used with limited success.Surgical management is associated with high morbidity and mortality. Endoscopic therapy using modalities such as the heater probe,neodymium:yttrium-aluminium-garnet laser,potassium titanyl phosphate laser and bipolar electrocoagulation has been reported to be of some benef it,but with frequent complications.Argon plasma coagulation is touted to be the preferred endoscopic therapy due to its eff icacy and safety profile.Newer methods of endoscopic ablation such as radiofrequency ablation and cryotherapy have been recently described which may afford broader areas of treatment per application,with lower rate of complications.This review will focus on endoscopic ablation therapies,including such newer modalities,for chronic radiation proctitis.展开更多
文摘Chronic radiation proctopathy occurs in 5%-20% of patients following pelvic radiotherapy. Although many cases resolve spontaneously,some lead to chronic symptoms including diarrhea,tenesmus,urgency and persistent rectal bleeding with iron deficiency anemia requiring blood transfusions. Treatments for chronic radiation proctitis remain unsatisfactory and the basis of evidence for various therapies is generally insuff icient. There are very few controlled or prospective trials,and comparisons between therapies are limited because of different evaluation methods. Medical treatments,including formalin,topical sucralfate,5-amino salicylic acid enemas,and short chain fatty acids have been used with limited success.Surgical management is associated with high morbidity and mortality. Endoscopic therapy using modalities such as the heater probe,neodymium:yttrium-aluminium-garnet laser,potassium titanyl phosphate laser and bipolar electrocoagulation has been reported to be of some benef it,but with frequent complications.Argon plasma coagulation is touted to be the preferred endoscopic therapy due to its eff icacy and safety profile.Newer methods of endoscopic ablation such as radiofrequency ablation and cryotherapy have been recently described which may afford broader areas of treatment per application,with lower rate of complications.This review will focus on endoscopic ablation therapies,including such newer modalities,for chronic radiation proctitis.
