Abstract
Purpose
Management of rectal bleeding in patients with radiation proctitis presents a conundrum for practitioners. Surgeons are appropriately concerned about using conventional methods of treatment in these patients, such as cautery for bleeding areas in the rectum, rubber band ligation, or excision of internal and/or external hemorrhoids, for fear of poor healing and possible exacerbation of the original problem. Few randomized controlled trials are available on the treatment of radiation proctitis alone, and no literature exists pertaining to the management of symptomatic hemorrhoids in the radiated patient.
Methods
In the absence of observational studies, the authors created an email survey to distribute to the membership of the American Society of Colon and Rectal Surgeons in order to try to identify current management practices for radiation proctitis and for the treatment of their symptomatic hemorrhoids.
Results
Of the 327 respondents, 85 % favored the use of topical formalin to treat radiation proctitis, while 42 % additionally used argon plasma coagulation. Only 25 % of practitioners report using sucralfate, though existing data on this therapy are promising. Regarding the management of hemorrhoids in patients with a history of rectal irradiation, 55 % of respondents hoped treatment of radiation proctitis alone would solve the problem. Forty-three percent reported using rubber band ligation, 30 % using hemorrhoidectomy, and 18 % using sclerotherapy.
Conclusions
While most respondents treated radiation proctitis alone in patients with symptomatic hemorrhoids, many also felt rubber band ligation, hemorrhoidectomy, and sclerotherapy are safe and effective alternative therapies in this population.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Raman R (2007) Two percent formalin retention enemas for hemorrhagic radiation proctitis: a preliminary report. Dis Colon Rectum 50:1–8
Tagkalidis P, Tjandra J (2001) Chronic radiation proctitis. ANZ J Surg 71:230–237
Denton AS, Andreyev JJ, Forbes A et al (2009) Non surgical interventions for late radiation proctitis inpatients who have received radical radiotherapy to the pelvis (Review). The Cochrane Collab 3:1–41
Kochhar R, Patel F, Dhar A et al (1991) Radiation-induced proctosigmoiditis. Prospective, randomized, double-blind controlled trial of oral sulfasalazine plus rectal steroids versus rectal sucralfate. Dig Dis Sci 36(1):103–107
Pinto A, Fidalgo P, Cravo M et al (1999) Short chain fatty acids are effective in short term treatment of chronic radiation proctitis. Dis Colon Rectum 42:788–796
Rougier P, Zimmerman P, Pignon JP, Kac J et al (1992) Radiation proctitis: comparing the effect of two rectal steroid preparations [Rectites radiques: efficate comparee de deux types de corticoides adminstre localement]. Med Chir Dig 21:91–93
Ehrenpreis ED, Jani A, Levitsky J et al (2005) A prospective randomised double-blind, placebo-controlled trial of vitamin A for symptomatic chronic radiation proctopathy. Dis Colon Rectum 48(1):1–8
Cavcic J, Turcic J, Martinac P et al (2000) Metronidazole in the treatment of chronic radiation proctitis: clinical trial. Croat Med J 41(3):314–318
Clark R, Tenorio C, Hussey J et al (2008) Hyperbaric oxygen treatment of chronic refractory radiation proctitis: a randomized and controlled double-blind crossover trial with long-term follow-up. Int J Radiat Oncol Biol Phys 72(1):134–143
Rubenstein E, Ibsen T, Rasmussen RB et al (1996) Formalin treatment of radiation-induced hemorrhagic proctitis. Am J Gastroenterol 81(1):44–45
Kochhar R, Sriram PV, Sharma SC et al (1999) Natural history of late radiation proctosigmoiditis treated with topical sucralfate suspension. Dig Dis Sci 44(5):973–978
Villavicencio RT, Rex DK, Rahmani E (2002) Efficacy and complications for argon plasma coagulation for hematochezia related to radiation proctopathy. Gastroint Endosc 55(1):70–74
Ginsberg G, Barkun A, Bosco J et al (2002) ASGE technology status evaluation report. Gastroint Endo 55(7):807–810
Jensen DM, Machicado GA, Cheng S et al (1997) A randomised prospective study of endoscopic bipolar electrocoagulation and heater probe treatment of chronic rectal bleeding from radiation telangiectasia. Gastrointest Endosc 45(1):20–25
Conflict of interest
None of the authors have any potential or real conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hawkins, M., Billingham, R. & Bastawrous, A. Hemorrhoid management in patients with radiation proctitis. Int J Colorectal Dis 27, 1673–1677 (2012). https://doi.org/10.1007/s00384-012-1512-9
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-012-1512-9