Randomized Control Trial Comparing Management of Radiation Proctocolitis with Sucralfate Instillation via Colonoscopy and Argon Plasma Coagulation
Sirikurnpiboon S, MD1, Wannaprasert J, MD1, Ratanachu-ek T, MD1
Affiliation : 1 Department of Surgery, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
Background : One frequent sequela after radiotherapy for pelvic cancer is radiation proctocolitis. Bleeding is a common clinical
presentation, with a wide range of severity. Radiation causes DNA, protein and lipid damage leading to mucosal friability and
neovascular telangiectasias. The present study compared the results of local management of radiation-induced proctocolitis and
evaluated factors related to failure under colonoscopy of sucralfate instillation and Argon plasma coagulator (APC).
Objective : To compare results of treatment of radiation proctitis with sucralfate to outcomes with APC.
Materials and Methods : The study was conducted from 2012 to 2016. Inclusion criteria were patients who were: (1) diagnosed
with radiation proctocolitis from clinical examination with colonoscopy and pathology; and (2) aged from 18 to 80 years. Exclusion
criteria were patients who: (1) Refused to undergo treatment; (2) had severe co-morbidities; or (3) were lost to follow-up. The
patients were randomized into 2 groups, and data was collected regarding patient demographics; previous cancer disease; onset
of clinical bleeding per rectum after last radiotherapy session, and hematocrit level before and during treatment.
Results : Of the 130 patients, 54 were randomised into the sucralfate group and the other 76 into the APC group. The mean age of the
sucralfate group was 62.15+10.00 compared with 62.27+8.07 in the APC group. Time to presentation after last radiotherapy
session were 7.16+4.97 and 6.15+4.18 years (p = 0.447), the first hematocrit before treatment were 34.86+4.61 and 32.17+6.52 (p
= 0.010), and the failure rate in treatment in the sucralfate and APC groups were 5.6% and 15.8% (p = 0.096) respectively. The factors
related to failure in both treatments were age >60 years, Hct at presentation <30 mg %, need blood transfusion, extension of disease
above rectum, high rectal telangiectasia distribution grade, full circumferential involvement, and ulceration.
Conclusion : Sucralfate instillation for treatment of radiation proctocolitis is not inferior to APC. The factors related to failure in
management were severity and extension of disease.
Keywords : Radiation proctitis, APC, Sucralfate, Colonoscopy
