Ankaferd blood stopper (ABS) is a standardized herbal extract
obtained from five different plants Thymus vulgaris
(thyme), Glycyrrhiza glabra (licorice),
Vitis vinifera (grape), Alpinia
officinarum (lesser galangal), and Urtica dioica
(stinging nettle) [1]
[2]
[3]. Here, we present the first case of successful ABS usage
in the therapy of radiation colitis.
A 71-year-old woman who had undergone pelvic radiotherapy due to
cancer of the cervix was admitted with rectal bleeding. Colonoscopy revealed
radiation rectosigmoiditis involving the area between 13 cm and
20 cm from the anal verge ([Fig. 1 a]). The lesion was severe according
to Wachter et al. [4] classification (congested mucosa:
grade 2; ulceration: grade 3; necrosis: grade 1).
A total of 20mL ABS solution was sprayed with a sclerotherapy needle
onto the lesion. This produced greyish–yellow discoloration and bleeding
stopped within seconds ([Fig. 1 b, c]). No sign of bleeding was
observed in the following days, and three further sessions were carried out on
a weekly basis to complete the healing. At follow-up, the giant ulcerated
lesion had almost disappeared, with only mild residual erosions and friability
remaining ([Fig. 2 a, b, c]). The patient
had only mild pelvic pain at the fifth week, despite ongoing friability of the
lesion area.
Fig. 1 Treatment of radiation
rectosigmoiditis using Ankaferd blood stopper (ABS) following pelvic
radiotherapy. a Large ulcerated lesion involving
two-thirds of the lumen at the rectosigmoid area. Edema, nodularity, and fresh
bleeding were also seen. b, c Bleeding stopped
and greyish–yellow coagulum covered the diseased area within seconds
after topical ABS application.
Fig. 2 Follow-up of the lesion
area. a The appearance of the healing ulcer one week
after end of treatment. b, c Near-complete
healing of ulcerated areas; some erosions and friability persisted at the fifth
week of follow-up.
The optimal treatment of bleeding due to radiation proctitis is
still controversial. Currently, argon plasma coagulation (APC) and local
application of formalin are being used as the main successful measures for
therapy of radiation colitis. APC treatment appears to be safer than formalin
[5].
ABS as a new hemostatic agent has been reported in various
gastrointestinal scenarios, namely Dieulafoy lesion [1],
solitary rectal ulcer [2], and neoplastic
gastrointestinal bleeding [3]. Upon application onto the
injured area, it induces a hemostatic protein network that stimulates
erythrocyte aggregation [1]. ABS may also offer an
exciting option in the therapy of radiation colitis, due to the ease of
application, speed of action, nontoxicity, and low cost.
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