الفهرس 
Gastrointestinal radiation injuryOnly 14 pages are availabe for public view
 |  | from | 80 |  |  |
| | | from | 80 | | |
Abstract
Chronic radiation proctopathy has an incidence of 5 –15% in patients with pelvic radiotherapy and rectal bleeding was the most common complication. Radiation injury to the rectal wall became apparent like obliterative endarteritis with secondary tissue ischemic and development of neovascular mucosal lesions. These ones could bleed in a delayed fashion and different amounts: from little sporadic spotting to episodes of severe rectal bleeding.
APC is a non-touch electrocoagulation technique in which high-frequency alternating current can be delivered to the target lesion by ionized gas. The limited depth of coagulation (0.5–3mm) explained the low risk of perforation, stenosis and fistulization.
Unlike traditional bipolar devices, APC could be applied axially and radially, allowing tangential coagulation of lesions around rectal bends without significant reduction in effectiveness.
This study was held on the steps of previous studies to assess the efficacy and safety of argon plasma coagulation for treatment of the pelvic radiotherapy–induced rectal vascular complications.
This study was applied prospectively on 32 patients presented to the Tropical Medicine and Oncology departments of Menoufia university hospitals over the period from December 2019 to October 2021 complaining of post-pelvic radiation complications.
After proctosigmoidoscopy, patients have been classified in to two groups, group I consisted of 16 patients that had bleeding per rectum due to severe form of radiation proctitis and group II consisted of 16 patients that had non-complicated angiodysplasia.
All patients with history of pelvic radiotherapy as a treatment for different malignant tumors in the last year were included in the study, then they were screened by procto-sigmoidoscopy for the presence of vascular complications or angiodysplasia, Patients presented with BPR as a complication of post radiation proctitis received medical treatment as oral or topical steroids or mesalamine were also included in the study.
All the included patients were subjected to the following:
Full history taking with stress on history of previous malignancy, history of last radiation session, previous symptomatic or conservative treatment for radiation-induced vascular complications as steroids, 5-ASA or supportive treatment. Clinical examination (general, abdominal and Rectal) for organomegaly, ascites, suprapubic masses, rectal bleeding or rectal mass. Laboratory investigations including: Complete blood count, liver profile, renal function tests, bleeding and coagulation profile, fecal occult blood test. Radiological investigations as abdominal ultrasonography and computed tomography (CT). Precolonoscopic evaluation and preparation before colonoscopy (hospitalization, resuscitation and diet preparations).
The mean age of the studied patients was 59.3 years (range 42 – 75years), 78.1% of studied patients were males and 21.9% were females.
The mean duration of last radiotherapy session was 9.53 months (range 6 - 12 months). Cancer prostate constituted 62.5% of the studied patients, while vesical cancer, colorectal cancer and gynecological malignancy represented 21.9 %, 6.3 % & 9.3 % respectively.
5(15.6%) patients presented with significant abdominal pain, one patient with chronic diarrhea, 2(6.3%) patients had tenesmus, 50% of patients had BPR and anemia presented in 24(75%) patients.
Regarding endoscopic score classification for HRP, our study proved that there is significant positive correlation between endoscopic score classification for HRP and the severity of bleeding.