Formalin irrigation for hemorrhagic chronic radiation proctitis.

Autor:	Ma TH; Teng-Hui Ma, Zi-Xu Yuan, Qing-Hua Zhong, Huai-Ming Wang, Qi-Yuan Qin, Xiao-Xia Chen, Jian-Ping Wang, Lei Wang, Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China., Yuan ZX; Teng-Hui Ma, Zi-Xu Yuan, Qing-Hua Zhong, Huai-Ming Wang, Qi-Yuan Qin, Xiao-Xia Chen, Jian-Ping Wang, Lei Wang, Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China., Zhong QH; Teng-Hui Ma, Zi-Xu Yuan, Qing-Hua Zhong, Huai-Ming Wang, Qi-Yuan Qin, Xiao-Xia Chen, Jian-Ping Wang, Lei Wang, Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China., Wang HM; Teng-Hui Ma, Zi-Xu Yuan, Qing-Hua Zhong, Huai-Ming Wang, Qi-Yuan Qin, Xiao-Xia Chen, Jian-Ping Wang, Lei Wang, Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China., Qin QY; Teng-Hui Ma, Zi-Xu Yuan, Qing-Hua Zhong, Huai-Ming Wang, Qi-Yuan Qin, Xiao-Xia Chen, Jian-Ping Wang, Lei Wang, Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China., Chen XX; Teng-Hui Ma, Zi-Xu Yuan, Qing-Hua Zhong, Huai-Ming Wang, Qi-Yuan Qin, Xiao-Xia Chen, Jian-Ping Wang, Lei Wang, Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China., Wang JP; Teng-Hui Ma, Zi-Xu Yuan, Qing-Hua Zhong, Huai-Ming Wang, Qi-Yuan Qin, Xiao-Xia Chen, Jian-Ping Wang, Lei Wang, Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China., Wang L; Teng-Hui Ma, Zi-Xu Yuan, Qing-Hua Zhong, Huai-Ming Wang, Qi-Yuan Qin, Xiao-Xia Chen, Jian-Ping Wang, Lei Wang, Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China.
Jazyk:	angličtina
Zdroj:	World journal of gastroenterology [World J Gastroenterol] 2015 Mar 28; Vol. 21 (12), pp. 3593-8.
DOI:	10.3748/wjg.v21.i12.3593
Abstrakt:	Aim: To assess the efficacy and safety of a modified topical formalin irrigation method in refractory hemorrhagic chronic radiation proctitis (CRP). Methods: Patients with CRP who did not respond to previous medical treatments and presented with grade II-III rectal bleeding according to the Common Terminology Criteria for Adverse Events were enrolled. Patients with anorectal strictures, deep ulcerations, and fistulas were excluded. All patients underwent flexible endoscopic evaluation before treatment. Patient demographics and clinical data, including primary tumor, radiotherapy and previous treatment options, were collected. Patients received topical 4% formalin irrigation in a clasp-knife position under spinal epidural anesthesia in the operating room. Remission of rectal bleeding and related complications were recorded. Defecation, remission of bleeding, and other symptoms were investigated at follow-up. Endoscopic findings in patients with rectovaginal fistulas were analyzed. Results: Twenty-four patients (19 female, 5 male) with a mean age of 61.5 ± 9.5 years were enrolled. The mean time from the end of radiotherapy to the onset of bleeding was 11.1 ± 9.0 mo (range: 2-24 mo). Six patients (25.0%) were blood transfusion dependent. The median preoperative Vienna Rectoscopy Score (VRS) was 3 points. Nineteen patients (79.2%) received only one course of topical formalin irrigation, and five (20.8%) required a second course. No side effects were observed. One month after treatment, bleeding cessation was complete in five patients and obvious in 14; the effectiveness rate was 79.1% (19/24). For long-term efficacy, 5/16, 1/9 and 0/6 patients complained of persistent bleeding at 1, 2 and 5 years after treatment, respectively. Three rectovaginal fistulas were found at 1 mo, 3 mo and 2 years after treatment. Univariate analysis showed associations of higher endoscopic VRS and ulceration score with risk of developing rectovaginal fistula. Conclusion: Modified formalin irrigation is an effective and safe method for hemorrhagic CRP, but should be performed cautiously in patients with a high endoscopic VRS.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu