TREATMENT OF HAEMORRHAGIC RADIATION PROCTITIS (HRP) BY ARGON PLASMA ELECTROCOAGULATION (APC): RESULTS AND COMPLICATIONS

Aims The aim is to determine the contribution of APC in the management of HRP.

Methods This is a retrospective and descriptive study between January 2009 and December 2018, including 46 patients with HRP. The technique used was a monopolar electrocoagulation with argon plasma.

Results The average age of patients was 59±16,5 years old and the sex ratio M/W was 1.1. Patients had no history of cardiovascular diseases and were not under anticoagulants, platelet aggregation inhibitors or NSAIDs. The main symptom was rectorrhagia found in all patients and the average clinical severity score of chutckan was 3,1. The average hemoglobin level was 9.6 g/dl. Radiotherapy was indicated in order of frequency for prostate, cervical, rectal and anal cancers. The average time to onset the symptomatology of HRP after pelvic radiation was 11 months and the diagnosis of HRP was confirmed by rectosigmoidoscopy in all patients who were all treated with APC. The average number of sessions required for the disappearance of rectorrhagia was 2.2 with extremes ranging from 1 to 6 sessions. The average duration of follow-up was 9 months. The evolution was marked by total disappearance of rectorrhagia in 74.2% of cases with a clear decrease of the clinical severity score of Chutkan from 3.1 to 0.65. Only 11 patients kept occasional small rectorrhagia without hemodynamic repercussions. After treatment, the hemoglobin level went from an average of 9.6 g/dl to 12.2 g/dl. Endoscopic control showed a marked improvement in rectal lesions and no major bleeding recurrence was mentioned. No short term or long term complications of APC were reported in our study.

Conclusions Our study confirms that endoscopic argon plasma coagulation treatment of HRP gives good results in terms of efficiency, tolerance and safety which proves its indication at first intention in the management of HRP.