Chronic radiation-induced proctitis is a common complication of pelvic radiotherapy
that frequently presents with rectal bleeding and mucosal friability. Argon plasma
coagulation (APC) is considered the first-line treatment for this condition [1]; however, it is associated with complications, such as rectal pain, ulceration,
and perforation [2]
[3]. Hybrid APC (hAPC), which combines high-pressure submucosal fluid injection with
thermal ablation [4], has shown promise in achieving hemostasis while minimizing the depth of thermal
injury to the muscular layer ([Fig. 1]). Here, we report a case of chronic radiation-induced proctitis successfully treated
with hAPC.
Fig. 1 The schema of hybrid argon plasma coagulation (hAPC). a The APC catheter was attached to the mucosa. b Submucosal fluid cushion was created by high-pressure injection without a needle.
c After injection, thermal ablation was carried out to the telangiectasia. d The presence of submucosal cushions helped ensure the safety of the thermal ablation
procedure.
A woman in her 50s with a history of laparoscopic radical hysterectomy and chemoradiotherapy
for cervical adenocarcinoma presented two years later with sintermittent hematochezia.
Colonoscopy revealed diffuse vascular ectasia with an oozing hemorrhage in the rectum
([Fig. 2]). The patient was diagnosed with chronic radiation-induced proctitis and hAPC was
performed ([Video 1]).
Fig. 2 The chronic radiation-induced proctitis in the rectum before hAPC treatment. There
was diffuse vascular ectasia with an oozing hemorrhage in the rectum.
Hybrid argon plasma coagulation procedure for chronic radiation-induced proctitis.Video
1
Treatment was performed using an APC catheter connected to an electrosurgical unit
(VIO APC 3; Erbe, Tübingen, Germany) and a needleless high-pressure waterjet system
(ERBEJET 2). First, a submucosal fluid cushion was created by injecting saline containing
indigo carmine. The tip of the catheter was slightly pressed against the mucosa to
ensure stability and the solution was injected. After injection, thermal ablation
was performed in the affected areas (using the forced APC effect 4). The presence
of a submucosal cushion ensured safe thermal ablation. We ablated all visible telangiectasia.
The patient reported no pain or adverse effects following the procedure. Follow-up
colonoscopy performed seven days after treatment revealed no visible bleeding ([Fig. 3]).
Fig. 3 The rectal lesion after hAPC treatment. Follow-up colonoscopy performed seven days
after hAPC revealed diffuse post-treatment erosions but no visible bleeding.
To our knowledge, this is the first report of the use of hAPC for radiation proctitis.
Thus, hAPC may be a highly effective and safe treatment option, particularly for bleeding
caused by telangiectasia, as observed in the present case.
Endoscopy_UCTN_Code_TTT_1AQ_2AZ
E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy.
All papers include a high-quality video and are published with a Creative Commons
CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission
process. We grant 100% waivers to articles whose corresponding authors are based in
Group A countries and 50% waivers to those who are based in Group B countries as classified
by Research4Life (see: https://www.research4life.org/access/eligibility/).
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos.
