| Argon plasma coagulation in the treatment of hemorrhagic radiation proctitis is efficient but requires a perfect colonic cleansing to be safe. | |
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MedLine Citation:
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PMID: 15618838 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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AIMS: We evaluate prospectively effectiveness, tolerance, predictive factors of failure and complications of argon plasma coagulation (APC) in the treatment of hemorrhagic radiation proctitis (HRP). PATIENTS AND METHODS: Twenty-seven patients were treated by APC for HRP. Eight patients needed blood transfusion before APC. Six patients were anti-coagulated and one had severe thrombocytopenia. APC was performed without sedation in 25/27 patients. Before APC treatment, bowel preparation was performed by enema (n = 19 sessions), polyethylene glycol or sodium phosphate (n = 53 sessions). APC treatment was performed every 5 weeks. Effectiveness of APC was based on clinical and endoscopic score and biological status before and after APC treatment. RESULTS: The mean follow-up was 13.6 months (range, 3-31 months). After one to seven sessions of APC (average, 2.66 sessions), twenty-five patients (92%) had no recurrence of bleeding. The bleeding score decreased from 3.03 to 0.42 (P < 0.001) and the endoscopic score from 3.08 to 0.73 (P < 0.001). Out of the eight patients requiring blood transfusion prior to APC sessions, only one required blood transfusion after APC (P < 0.05). One late relapse was observed and successfully re-treated by APC. Side effects were anal or rectal pain (n = 3) and vagal symptoms (n = 2). Three colonic explosions occurred, with perforation leading to surgery in one case. The incidence of bowel explosion was higher after local preparation (3/19 sessions) compared with oral preparation (0/53 sessions) (P < 0.05). No stricture due to APC appeared, even if telangiectasias coagulated during a session were circumferential. CONCLUSION: Coagulation by APC is an effective and safe treatment of HRP if a complete cleansing preparation is performed to avoid explosion. |
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Authors:
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E Ben-Soussan; M Antonietti; G Savoye; S Herve; P Ducrotté; E Lerebours |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: European journal of gastroenterology & hepatology Volume: 16 ISSN: 0954-691X ISO Abbreviation: Eur J Gastroenterol Hepatol Publication Date: 2004 Nov |
Date Detail:
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Created Date: 2004-12-24 Completed Date: 2005-03-17 Revised Date: 2009-10-16 |
Medline Journal Info:
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Nlm Unique ID: 9000874 Medline TA: Eur J Gastroenterol Hepatol Country: England |
Other Details:
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Languages: eng Pagination: 1315-8 Citation Subset: IM |
Affiliation:
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Department of Gastroenterology, Rouen University Hospital Charles Nicolle, Rouen, France. Emmanuel.Ben-soussan@chu-rouen.fr |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Administration, Oral Aged Aged, 80 and over Argon Blood Transfusion Cathartics / administration & dosage Colon / radiation effects Electrocoagulation / adverse effects, methods* Enema / methods Female Gastrointestinal Hemorrhage / surgery* Humans Male Middle Aged Phosphates / administration & dosage Polyethylene Glycols / administration & dosage Proctitis / etiology, surgery* Prospective Studies Radiation Injuries / complications, surgery* Rectal Diseases / surgery Solvents / administration & dosage |
| Chemical | |
Reg. No./Substance:
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0/Cathartics; 0/Phosphates; 0/Polyethylene Glycols; 0/Solvents; 7440-37-1/Argon; 7632-05-5/sodium phosphate |
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