RESUMO
BACKGROUND AND STUDY AIM: Chronic radiation coloproctopathy (CRCP) is a well-recognized complication of radiotherapy, with rectal bleeding the most common presentation. It is frequently refractory to conservative management, but the optimal endoscopic treatment of bleeding secondary to CRCP is still controversial. The efficacy and safety of bipolar eletrocoagulation (BEC) and argon plasma coagulation (APC) in the management of bleeding from CRCP were evaluated and compared. PATIENTS AND METHODS: 30 patients (mean age 67.4 years) with active and chronic bleeding from telangiectasias, were randomly allocated to BEC or APC and stratified by severity of CRCP according to clinical severity and endoscopic findings (Saunders score). Success was defined as eradication of all telangiectasias, and therapeutic failure as need for more than seven sessions or for other treatment. Complications were categorized as minor (e.g. fever, anal or abdominal pain) or major (hemorrhagic). RESULTS: Both treatments were equally effective for the treatment of CRCP rectal bleeding. Only one failure was observed in each group (P = 1.000). There was no significant difference between the two groups regarding number of sessions, minor or major complications, or relapse. However, overall complication rate was significantly higher in the BEC group (P = 0.003). CONCLUSIONS: BEC and APC are both effective for the therapy of bleeding telangiectasias from CRCP. There are probably no major differences between them. Although APC seemed safer than BEC in this investigation, further studies, involving a much larger population, are needed to assess the complication rates and determine the best management option.
Assuntos
Eletrocoagulação/métodos , Hemorragia Gastrointestinal/cirurgia , Lesões por Radiação/cirurgia , Radioterapia/efeitos adversos , Doenças Retais/cirurgia , Doenças do Colo Sigmoide/cirurgia , Telangiectasia/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Coagulação com Plasma de Argônio/efeitos adversos , Doença Crônica , Colo Sigmoide/efeitos da radiação , Eletrocoagulação/efeitos adversos , Neoplasias do Endométrio/radioterapia , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Análise de Intenção de Tratamento , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/radioterapia , Lesões por Radiação/complicações , Doenças Retais/etiologia , Reto/efeitos da radiação , Índice de Gravidade de Doença , Doenças do Colo Sigmoide/etiologia , Telangiectasia/complicações , Resultado do Tratamento , Neoplasias do Colo do Útero/radioterapiaRESUMO
AIM: Argon plasma coagulation (APC) is considered a safe treatment for haemorrhagic chronic radiation proctocolitis (CRPC), but bacteraemia is a rare complication. The study aimed to evaluate the frequency of bacteraemia after APC. METHOD: A prospective study of 21 patients who underwent APC (30 procedures) for CRPC was carried out. Blood cultures (Bactec(®) ) were obtained before and 30 min after the procedure (60 samples total). Patients were monitored for 48 h after the procedure to detect signs of infection. RESULTS: None of the 21 patients had fever or any sign suggestive of infection after any of the 30 sessions. All baseline blood cultures were negative and two (7%) of the 30-min blood cultures were positive (Staphylococcus hominis n = 1; Streptococcus bovis and Rhodotorula sp n = 1). The first was likely to be a contaminant and the second patient had no evidence of any other colonic disease (neoplasia or polyps) beside CRPC. CONCLUSION: APC is a low-risk procedure regarding bacteraemia and does not warrant prophylactic antibiotic administration.
