Year 2023 / Volume 115 / Number 9
Original
Risk factors associated to argon plasma coagulation treatment failure in patients with chronic radiation proctopathy

480-487

DOI: 10.17235/reed.2023.9258/2022

Edgardo Amaya-Fragoso, Angélica Iztaccíhuatl Hernández Guerrero, Luis Guillermo Beltrán-Galindo,

Abstract
Background: argon plasma coagulation (APC) is the current endoscopic treatment of choice for patients who develop chronic radiation proctopathy. The aim of this study was to identify risk factors associated with treatment failure. Methods: one hundred and ninety-nine patients treated with argon plasma coagulation in a single center were retrospectively analyzed. Results: twenty-four (12.06 %) patients were classified as APC treatment failures. Requirement of red blood cells transfusion and/or hemoglobin < 7 g/dl (OR 12.19, 95 % CI: 2.78-53.45, p < 0.001) and severe bleeding frequency (OR 2.76, 95 % CI: 1.13-6.72, p = 0.03) at diagnosis and prior to endoscopic therapy were associated with argon plasma coagulation treatment failure. Nineteen patients of the successful therapy group developed bleeding recurrence; no risk factors were associated with a shorter recurrence-free time. More than four APC sessions were associated to a higher risk of surgical intervention for bleeding control (OR 87.00, 95 % CI: 10.23-740.18, p < 0.001). Conclusion: requirement of red blood cells transfusion and/or hemoglobin < 7 g/dl and a severe bleeding frequency (more than five days per week) were identified as the most important risk factors for treatment failure in patients with chronic radiation proctopathy.
Lay Summary
Chronic radiation proctopathy is a complication from radiation therapy, observed in up to one third of patients with pelvic neoplasms. It is characterized by tortuous blood vessels in the rectal mucosa and the onset of rectal bleeding, which ultimately leads to anemia, transfusion and/or need for surgical interventions. Endoscopic management with argon plasma coagulation (an ionized gas with voltage that creates plasma beams) is the standard of treatment with high success rates. However, approximately one out of ten patients will not improve with this therapy, and it is unclear who will not respond. In our study, we found that patients with low hemoglobin and/or requirement of red blood cells transfusion at presentation, and frequent rectal bleeding (more than five times per week) were more likely to be nonresponders to argon therapy. Furthermore, up to four sessions of endoscopic treatment seems to be enough to assess if a patient will respond to therapy. Patients with persistent rectal bleeding after four sessions are at a higher risk of being nonresponders and will probably require surgical intervention as treatment. We believe these findings might help other clinicians to identify high-risk patients that probably will not respond to further endoscopic argon therapy.
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References
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Amaya-Fragoso E, Hernández Guerrero A, Beltrán-Galindo L. Risk factors associated to argon plasma coagulation treatment failure in patients with chronic radiation proctopathy. 9258/2022


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Publication history

Received: 05/10/2022

Accepted: 23/12/2022

Online First: 16/01/2023

Published: 06/09/2023

Article revision time: 77 days

Article Online First time: 103 days

Article editing time: 336 days


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