Use of argon plasma coagulator for bleeding due to radiation-induced proctitis

The efficacy of Argon plasma coagulator on rectal bleeding from chronic radiation-induced proctitis was examined. Five consecutive cases, age 55-75 years, with rectal bleeding (estimated > 10 ml/bowel action) and sigmoidoscopic findings of mucosal pallor, telangiectasiae, more than 6 months after pelvic irradiation, were entered. After failing to respond to topical mesalazine for 4 weeks, treatment with Argon plasma coagulator was given every 2 to 4 weeks. Haemoglobin, number of bloody bowel actions and number of telangiectasiae was recorded at each visit. After a median 6 visits (range 5-8), the number of telangiectasiae was reduced from median 33 (range 24 to 43) to 3 (range 1-5). The number of bloody bowel actions also decreased from median 3 (range 2-5) to 1 (range 0 to 2). Haemoglobin concentration improved in all 5 cases. Two transfusion dependent patients required 3 and 4 units per month respectively before treatment and none for 6 months after treatment. Chronic rectal ulcers did not develop and telangiectasiae did not recur 6 months after completion of treatment. These results indicate that Argon plasma coagulator reduces bleeding and transfusion requirements in chronic radiation-induced proctitis. In this small series there were no complications.