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Effectiveness of argon plasma coagulation in the treatment of chronic actinic proctitis
Tormo,V.; Wikman Jorgensen,P.; García del Castillo,G.; Ruiz,F.; Martínez Egea,A.;
Revista Espa?ola de Enfermedades Digestivas , 2009, DOI: 10.4321/S1130-01082009000200002
Abstract: introduction: there are two kinds of actinic proctitis - one is acute and self-limited, and lasts about 3 months; the other is chronic and develops months to years after radiation therapy. the incidence of chronic actinic proctitis is about 5-20% of radiated prostate tumors. objective: to evaluate the effectiveness of argon plasma coagulation in the treatment of chronic actinic proctitis. material and method: a retrospective search of patients with the diagnosis of actinic proctitis. the number of argon plasma coagulation therapies needed to achieve the symptom resolution was analyzed. results: we found 22 patients with a diagnosis of actinic proctitis. nineteen were males (86.7%) and three (13.6%) were females. nineteen patients (86.4%) had a diagnosis of prostate adenocarcinoma, one had a diagnosis of squamous-cell cervix carcinoma (4.5%), and two had a diagnosis of endometrial carcinoma (9.1%). the mean number of coagulation sessions needed for symptom resolution was 2.58 (absolute range 1-7) with a median of 2 sessions. conclusion: multiple treatments are described in the literature. none of them have shown promising results. our results suggest that argon plasma coagulation is effective in the treatment of this condition, and achieves a rapid and sustained response with few sessions and a good safety profile.
Conservative therapies for hemorrhagic radiation proctitis: a review
Cotti, Guilherme;Seid, Victor;Araujo, Sérgio;Souza Jr., Afonso Henrique Silva e;Kiss, Desidério Roberto;Habr-Gama, Angelita;
Revista do Hospital das Clínicas , 2003, DOI: 10.1590/S0041-87812003000500008
Abstract: chronic radiation proctitis represents a challenging condition seen with increased frequency due to the common use of radiation for treatment of pelvic cancer. hemorrhagic radiation proctitis represents the most feared complication of chronic radiation proctitis. there is no consensus for the management of this condition despite the great number of clinical approaches and techniques that have been employed. rectal resection represents an available option although associated with high morbidity and risk of permanent colostomy. the effectiveness of nonoperative approaches remains far from desirable, and hemorrhagic recurrence represents a major drawback that leads to a need for consecutive therapeutic sessions and combination of techniques. we conducted a critical review of published reports regarding conservative management of hemorrhagic chronic radiation proctitis. although prospective randomized trials about hemorrhagic radiation proctitis are still lacking, there is enough evidence to conclude that topical formalin therapy and an endoscopic approach delivering an argon plasma coagulation represent available options associated with elevated effectiveness for interruption of rectal bleeding in patients with chronic radiation proctitis.
Conservative therapies for hemorrhagic radiation proctitis: a review  [cached]
Cotti Guilherme,Seid Victor,Araujo Sérgio,Souza Jr. Afonso Henrique Silva e
Revista do Hospital das Clínicas , 2003,
Abstract: Chronic radiation proctitis represents a challenging condition seen with increased frequency due to the common use of radiation for treatment of pelvic cancer. Hemorrhagic radiation proctitis represents the most feared complication of chronic radiation proctitis. There is no consensus for the management of this condition despite the great number of clinical approaches and techniques that have been employed. Rectal resection represents an available option although associated with high morbidity and risk of permanent colostomy. The effectiveness of nonoperative approaches remains far from desirable, and hemorrhagic recurrence represents a major drawback that leads to a need for consecutive therapeutic sessions and combination of techniques. We conducted a critical review of published reports regarding conservative management of hemorrhagic chronic radiation proctitis. Although prospective randomized trials about hemorrhagic radiation proctitis are still lacking, there is enough evidence to conclude that topical formalin therapy and an endoscopic approach delivering an argon plasma coagulation represent available options associated with elevated effectiveness for interruption of rectal bleeding in patients with chronic radiation proctitis.
Effectiveness of argon plasma coagulation in the treatment of chronic actinic proctitis Efectividad de la fulguración con argón plasma en el tratamiento de la proctitis actínica crónica  [cached]
V. Tormo,P. Wikman Jorgensen,G. García del Castillo,F. Ruiz
Revista Espa?ola de Enfermedades Digestivas , 2009,
Abstract: Introduction: there are two kinds of actinic proctitis - one is acute and self-limited, and lasts about 3 months; the other is chronic and develops months to years after radiation therapy. The incidence of chronic actinic proctitis is about 5-20% of radiated prostate tumors. Objective: to evaluate the effectiveness of argon plasma coagulation in the treatment of chronic actinic proctitis. Material and method: a retrospective search of patients with the diagnosis of actinic proctitis. The number of argon plasma coagulation therapies needed to achieve the symptom resolution was analyzed. Results: we found 22 patients with a diagnosis of actinic proctitis. Nineteen were males (86.7%) and three (13.6%) were females. Nineteen patients (86.4%) had a diagnosis of prostate adenocarcinoma, one had a diagnosis of squamous-cell cervix carcinoma (4.5%), and two had a diagnosis of endometrial carcinoma (9.1%). The mean number of coagulation sessions needed for symptom resolution was 2.58 (absolute range 1-7) with a median of 2 sessions. Conclusion: multiple treatments are described in the literature. None of them have shown promising results. Our results suggest that argon plasma coagulation is effective in the treatment of this condition, and achieves a rapid and sustained response with few sessions and a good safety profile. Introducción: existen 2 tipos de proctitis actínica, una aguda autolimitada, que dura aproximadamente 3 meses y otra crónica que aparece a los meses o a os de la radioterapia. La incidencia de proctitis actínica crónica es del 5-20% de los tumores prostáticos irradiados. Objetivo: evaluar la efectividad de la fulguración con argón plasma en el tratamiento de este tipo de proctitis. Material y método: estudio retrospectivo. Realizamos una búsqueda retrospectiva de aquellos pacientes diagnosticados de proctitis actínica entre 2004 y 2007. Analizamos el número de sesiones de fulguración con plasma de argón que fueron necesarias para la resolución de la sintomatología. Resultados: hemos hallado 22 pacientes con el diagnóstico de proctitis actínica. Diecinueve de los pacientes eran varones (86,4%) y tres mujeres (13,6%). De todos los pacientes 19 fueron diagnosticados de adenocarcinoma prostático (86,4%), una fue diagnosticada de carcinoma epidermoide de cérvix uterino (4,5%) y dos fueron diagnosticadas de adenocarcinoma de endometrio (9,1%). La media de sesiones de fulguración con plasma de argón necesarias para resolución de la clínica presentada fue de 2,58 (rango entre 1 y 7 sesiones) y con un mediana de 2 sesiones. Conclusión: en la literatura
Argón plasma versus formol al 4% en el manejo endoscópico de la proctitis actínica sangrante Argon plasma coagulation versus aplication of 4 percent formalin for the treatment of radiation induced hemorrhagic proctitis  [cached]
Rodrigo Casta?o Llano,Juan Darío Puerta D,José Ignacio Restrepo,Juan Ricardo Márquez
Revista Colombiana de Gastroenterologia , 2007,
Abstract: Antecedentes: la proctitis actínica es una complicación frecuente de la radioterapia para neoplasias pélvicas. En su forma más severa puede llevar a hemorragias masivas con necesidad de atención hospitalaria repetida y transfusiones de sangre. La terapia médica de la proctitis actínica es frecuentemente inefectiva, mientras que la cirugía cursa con una alta morbimortalidad. Objetivos: se pretende comparar los resultados terapéuticos con el argón plasma (AP) (ERBE USA, Inc., Marietta, GA, USA) en pacientes con hemorragia inducida por la proctitis actínica versus una cohorte histórica manejada con la instilación endoscópica de formol al 4%. Materiales y métodos: el AP se aplicó atendiendo a la técnica de "no tocar" con una potencia de 50-60 Watt y a un flujo de argón de 2 l/min. Se predeterminó una duración de los pulsos inferiores a 1 segundo. El tratamiento se hizo a intervalos de cada 2 a 4 semanas cuando se requirió. La terapia con formol al 4% se hizo por un operador usando 20 ml e instilándolo directamente al recto por 5 minutos mediante un endoscopio flexible. Se pretende con la técnica un contacto no muy prolongado con el formol. Resultados: los dos grupos son comparables en términos de edad, género y diagnóstico. En 26 pacientes (24 mujeres) con hemorragia por proctitis actínica se aplicó formol al 4% y 21 se trataron con AP (18 mujeres). Los pacientes que recibieron formol tuvieron la radioterapia en promedio 14 meses atrás (rango 7-28) y los tratados con AP de 9 meses (rango 6-18). El tiempo promedio de sangrado antes de la terapia fue de 7 meses (rango de 4-14) para el tratamiento con formol y de 5,5 meses (rango 3-11) para el grupo con AP. El promedio de administración de unidades de sangre fue de 2,6 unidades (rango 0-6) para el grupo con formol y de 1,8 (rango de 0-4) para los tratados con AP. En el grupo con formol tres pacientes requirieron más de una terapia y en el grupo con AP cuatro pacientes. No hubo necesidad de más transfusiones ni hubo resangrados importantes en el seguimiento de los dos grupos que fue en promedio de 20 meses (rango 6-35). Conclusiones: la terapia endoscópica con formol al 4% es simple, barata y efectiva para el tratamiento del sangrado por proctitis actínica y sus resultados son comparables al tratamiento con AP. Background: Radiation proctitis is a common complication of radiotherapy for pelvic malignancy. In more severe form, it leads to intractable or massive hemorrhage, which may require repeated hospital admissions and blood transfusions. Medical therapy in patients with radiation proctitis is usually ineffec
TRATAMIENTO DE LA PROCTITIS ACTINICA CON ARGON PLASMA: PRIMERA EXPERIENCIA EN CUBA Actinic Proctitis treatment with Argon Plasma Coagulation  [cached]
Rolando Martínez López,Osvaldo Díaz-Canel Fernández,Julián Ruiz Torres,Vivianne Anido Escobar
Revista Habanera de Ciencias M??dicas , 2008,
Abstract: Se presenta reporte preliminar de una investigación prospectiva con la aplicación de la endoscopia terapéutica en pacientes con Proctitis radiógena procedentes de la consulta externa del Instituto Nacional de Oncología y Radiobiología, en los que se aplica Argón Plasma Coagulación (APC) para ablación de las lesiones vasculares, como consecuencia del efecto de las radiaciones en el recto. Se detalla la aplicación del método terapéutico en 20 pacientes, todos del sexo femenino, el síntoma cardinal en todos los casos fue el sangrado rectal, el promedio de sesiones de tratamiento fue de 3 y todos los casos refirieron mejoría evidente por disminución del sangrado desde la primera sesión, con disminución importante o eliminación de las telangiectasias durante el seguimiento y no se presentaron complicaciones mayores con el procedimiento. Se considera que el tratamiento endoscópico constituye un método valioso y una opción factible, segura y eficaz para el tratamiento de la proctitis actínica. We performed a prospective research applying therapeutic endoscopy in patients suffering of Actinic Proctitis, after radiation for pelvic cancer. We used Argon Plasma Coagulation to remove vascular lesions in these patients. We described the application of this therapeutic in 20 patients, all of them female, with rectal bleeding. Patients received as average, 3 sessions of treatment, and all of the them get better since the first session, with importantreduction of the bleeding and the number of telangiectasias. There were no complications with this technique. We consider that therapeutic endoscopic treatment with APC is a valuable and safe treatment for patients, suffering with Actinic Proctitis.
Tratamiento tópico con formalina en la proctitis actínica hemorrágica Topical formalin treatment of radiation-induced hemorrhagic proctitis  [cached]
A. Garrido,A. Giráldez,F. Pareja,J. L. Márquez
Revista Espa?ola de Enfermedades Digestivas , 2009,
Abstract:
Efficacy and safety of argon plasma coagulation for the treatment of hemorrhagic radiation proctitis
Serna Higuera,C. de la; Martín Arribas,M. I.; Rodríguez Gómez,S. J.; Pérez Villoria,A.; Martínez Moreno,J.; Betancourt González,A.;
Revista Espa?ola de Enfermedades Digestivas , 2004, DOI: 10.4321/S1130-01082004001100003
Abstract: objective: to evaluate the efficacy, safety and medium-/long-term clinical course of patients undergoing endoscopic treatment with argon plasma coagulation for hemorrhagic radiation proctopathy. design: descriptive, retrospective study with medium- and long-term follow-up. patients, material and methods: ten patients were treated with argon plasma coagulation for hemorrhagic radiation proctopathy between july 1998 and february 2003. inclusion criteria were: evidence of chronic rectal bleeding, consistent endoscopic findings, and absence of any other cause of hematochezia after a comprehensive ano-rectal examination and complete colonoscopy. the equipment used was a standard colonoscope, an argon delivery unit, an argon plasma coagulation probe 1.5 mm in internal diameter, and a high-frequency electrosurgical generator. consecutive treatment sessions were programmed whenever it was considered necessary until all mucosal lesions had been treated. clinical and evolutive follow-up was performed with a focus on tolerance, efficacy, and potential argon plasma coagulation-related complications. data were updated by personal or telephonic interview. results: in all patients, chronic rectal bleeding stopped after the last treatment session. the mean number of treatment sessions to stop symptoms was 1.7. mean follow-up was 31.1 months. all sessions were well tolerated, similarly to standard rectoscopy. in one case a recurrence of rectal bleeding was observed four months later, which required two repeat sessions. four patients were anemic at inclusion. three of them reported a resolved anemia at the end of the study. no delayed argon plasma coagulation-related complications such us ulcers or strictures were seen. conclusions: argon plasma coagulation appears to be a useful, effective and safe treatment for rectal bleeding resulting from chronic radiation proctitis when compared to standard medical and endoscopic treatments. these successful outcomes seem to persist even after
Argón plasma versus formol al 4% en el manejo endoscópico de la proctitis actínica sangrante
Casta?o Llano,Rodrigo; Puerta D,Juan Darío; Restrepo,José Ignacio; Márquez,Juan Ricardo; Ruiz Vélez,Mario H; Sanín Fonnegra,Eugenio; Juliao Ba?os,Fabián; Erebrie Granados,Faruk; Nú?ez Cabarcas,Edilberto; García,Luz Helena;
Revista Colombiana de Gastroenterologia , 2007,
Abstract: background: radiation proctitis is a common complication of radiotherapy for pelvic malignancy. in more severe form, it leads to intractable or massive hemorrhage, which may require repeated hospital admissions and blood transfusions. medical therapy in patients with radiation proctitis is usually ineffective, whereas surgery is associated with a high morbidity and mortality. objectives: to compare the therapeutic results of the argon plasma coagulator (ap) (erbe usa, inc., marietta, ga, usa) application in patients with radiation proctitis-induced haemorrhage versus a historic cohort treated with 4% formalin irrigation. material and methods: ap was performed, applying the no-touch spotting technique at an electrical power of 50-60 watt and an argon gas flow of 2 l/min. pulse duration was less than 1 second. treatment sessions were carried out at intervals of 2-4 weeks when was required. patients with formalin were treated by a single operator using 20 ml of a 4% solution of formalin instilled into the rectum via a flexible colonoscope for 5 minutes. the technique used ensured minimal contact with formalin results: the two groups were comparable in terms of age, sex, and diagnosis. twenty six patients (24 females) with hemorrhagic radiation proctitis were treated with endoluminal formalin and 21 with ap (18 females). patients with formalin were treated with radiotherapy at a median time of 14 months (range, 7-28 months) previously and 9 months (range, 6-18) in ap therapy. the median duration of time of symptomatic rectal haemorrhage before formalin therapy was 7 months (range, 4-14 months) and 5,5 months (range, 3-11 months). the median number of units of blood transfused previously per patient was 2,6 (range, 0-6) and 1,8. three patients required repeat formalin application and four in ap group. there was not severe bleeding with any of the groups of treatment, nor was any blood transfusion needed, at follow-up mean of 20 months (range, 6-35 months). conclusions: f
Efficacy and safety of argon plasma coagulation for the treatment of hemorrhagic radiation proctitis Eficacia y seguridad de la electrocoagulación con plasma de argón en el tratamiento del sangrado rectal secundario a proctitis por radioterapia  [cached]
C. de la Serna Higuera,M. I. Martín Arribas,S. J. Rodríguez Gómez,A. Pérez Villoria
Revista Espa?ola de Enfermedades Digestivas , 2004,
Abstract: Objective: to evaluate the efficacy, safety and medium-/long-term clinical course of patients undergoing endoscopic treatment with argon plasma coagulation for hemorrhagic radiation proctopathy. Design: descriptive, retrospective study with medium- and long-term follow-up. Patients, material and methods: ten patients were treated with argon plasma coagulation for hemorrhagic radiation proctopathy between July 1998 and February 2003. Inclusion criteria were: evidence of chronic rectal bleeding, consistent endoscopic findings, and absence of any other cause of hematochezia after a comprehensive ano-rectal examination and complete colonoscopy. The equipment used was a standard colonoscope, an argon delivery unit, an argon plasma coagulation probe 1.5 mm in internal diameter, and a high-frequency electrosurgical generator. Consecutive treatment sessions were programmed whenever it was considered necessary until all mucosal lesions had been treated. Clinical and evolutive follow-up was performed with a focus on tolerance, efficacy, and potential argon plasma coagulation-related complications. Data were updated by personal or telephonic interview. Results: in all patients, chronic rectal bleeding stopped after the last treatment session. The mean number of treatment sessions to stop symptoms was 1.7. Mean follow-up was 31.1 months. All sessions were well tolerated, similarly to standard rectoscopy. In one case a recurrence of rectal bleeding was observed four months later, which required two repeat sessions. Four patients were anemic at inclusion. Three of them reported a resolved anemia at the end of the study. No delayed argon plasma coagulation-related complications such us ulcers or strictures were seen. Conclusions: argon plasma coagulation appears to be a useful, effective and safe treatment for rectal bleeding resulting from chronic radiation proctitis when compared to standard medical and endoscopic treatments. These successful outcomes seem to persist even after long-term follow-up. Objetivo: evaluar la eficacia, seguridad y curso evolutivo a medio/largo plazo de los pacientes tratados endoscópicamente con plasma de argón en nuestra unidad por sangrado rectal asociado a proctitis por radioterapia. Dise o: estudio descriptivo y retrospectivo a medio/largo plazo. Pacientes, material y métodos: entre julio de 1998 y febrero de 2003, se trataron con plasma de argón 10 pacientes que presentaron rectorragia secundaria a proctitis por radioterapia. Se consideraron criterios de inclusión la existencia de sangrado rectal crónico, presencia de hallazgos endoscó
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