Document Detail


Argon plasma coagulation in the treatment of hemorrhagic radiation proctitis is efficient but requires a perfect colonic cleansing to be safe.
MedLine Citation:
PMID:  15618838     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
E Ben-Soussan; M Antonietti; G Savoye; S Herve; P Ducrotté; E Lerebours
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of gastroenterology & hepatology     Volume:  16     ISSN:  0954-691X     ISO Abbreviation:  Eur J Gastroenterol Hepatol     Publication Date:  2004 Nov 
Date Detail:
Created Date:  2004-12-24     Completed Date:  2005-03-17     Revised Date:  2009-10-16    
Medline Journal Info:
Nlm Unique ID:  9000874     Medline TA:  Eur J Gastroenterol Hepatol     Country:  England    
Other Details:
Languages:  eng     Pagination:  1315-8     Citation Subset:  IM    
Affiliation:
Department of Gastroenterology, Rouen University Hospital Charles Nicolle, Rouen, France. Emmanuel.Ben-soussan@chu-rouen.fr
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MeSH Terms
Descriptor/Qualifier:
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:
0/Cathartics; 0/Phosphates; 0/Polyethylene Glycols; 0/Solvents; 7440-37-1/Argon; 7632-05-5/sodium phosphate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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