A case of hemorrhagic chronic radiation proctitis treated successfully by Argon Plasma Coagulation

Chronic radiation proctitis (CRP) occurs in 2%─20% of patients undergoing pelvic radiotherapy. The symptoms of CRP include diarrhea, tenesmus, rectal pain and persistent rectal bleeding, rectal bleeding being the most common symptom. While most standard treatments for CRP, including medical, surgical and endoscopic treatments, remain unsatisfactory, endoscopic argon plasma coagulation (APC) is reported as an effective, efficient and reasonably safe non-contact method for the treatment of hemorrhagic CRP. While APC is reported to be associated with limited complications, major ulcers, strictures and fistulas have been reported previously, and careful monitoring and attention are necessary. We report the case of a 78-year-old man who presented with rectal bleeding after having undergone radiation therapy for prostatic cancer six months earlier. Endoscopic examination revealed hemorrhages and multiple rectal telangiectasias, and the patient was diagnosed as having CRP. Three sessions of brief pulse APC under the power setting of 30 W and argon flow rate of 0.6 l/min were performed, and complete hemostasis was achieved with no complications. Post-procedure follow-up endoscopy performed two months later revealed no telangiectasias or complications. In conclusion, plural therapy of brief pulse APC for CRP using a low power setting and low argon flow rate seems to be useful to reduce the complications of APC for the treatment of CRP.