Journal of Gastroenterology and Hepatology (2004) 19, 1169–1173 DOI: 10.1111/j.1400-1746.2004.03448.x Blackwell Science, LtdOxford, UKJGHJournal of Gastroenterology and Hepatology0815-93192004 Blackwell Publishing Asia Pty Ltd191011691173Original Article Endoscopic treatment of radiation proctopathyS Sebastianet al. Correspondence: Dr S Sebastian, Department of Gastroenterology, Adelaide and Meath Hospital, Tallaght, Dublin 24, Republic of Ireland. Email: sebastianshaji@eircom.net Accepted for publication 8 December 2003. GASTROENTEROLOGY Argon plasma coagulation as first-line treatment for chronic radiation proctopathy SHAJI SEBASTIAN, HUMPHREY O’CONNOR, COLM O’MORAIN AND MARTIN BUCKLEY Department of Gastroenterology, Adelaide and Meath Hospital incorporating the National Children’s Hospital, Tallaght, Dublin and Faculty of Health Sciences, Trinity College, Dublin, Ireland Abstract Background and Aim: Chronic radiation proctopathy is a troublesome complication of radiotherapy to the pelvis, for which current treatment modalities are unsatisfactory. The present prospective study was designed to determine the usefulness and safety of argon plasma coagulation in the management of chronic radiation proctopathy. Methods: Twenty-five consecutive patients (M:F 24:1, mean age: 69 years) with radiation proctopathy were prospectively included. All patients received argon plasma coagulation by a standard protocol. Response to treatment was assessed by symptom response, bleeding severity score, hematological parameters and transfusion requirements over a median 14-month follow up. Results: Patients received a median of one treatment session with argon plasma coagulation. There was significant improvement in rectal bleeding in all patients, with complete cessation of bleeding in 21 (81%) of the patients. The median bleeding severity score fell from 3 to 0 (P < 0.0005). The mean hemo- globin level rose from 10.05 ± 2.21 g/dL before treatment to 12.44 ± 1.09 g/dL at 6 months following treatment (P < 0.002). There was also improvement in other symptoms such as urgency and diarrhea. Over the period of follow up, there was no recurrence of anemia and no complications were noted. Conclusion: These results suggest that argon plasma coagulation is a safe and effective modality in the treatment of chronic radiation proctopathy. © 2004 Blackwell Publishing Asia Pty Ltd Key words: argon plasma coagulation, radiation proctopathy. INTRODUCTION Chronic radiation proctopathy is a troublesome long- term complication of radiotherapy for carcinoma of the prostate and other pelvic malignancies and occurs in 5– 7.5% of patients receiving pelvic irradiation. 1 Radia- tion-induced mucosal damage results in endothelial dysfunction, microvascular injury, ischemia, fibrosis, and the development of neovascular lesions. 2 Chronic radiation proctopathy resolves spontaneously in many cases but in some patients can lead to persistent rectal bleeding and iron deficiency anemia requiring blood transfusion. 3 Other symptoms of chronic radiation proctopathy include diarrhea, mucoid discharge, urgency, tenesmus, rectal pain, and fecal incontinence. These symptoms interfere with activities of daily living and have an adverse effect on quality of life. 4 The treatment of chronic radiation proctopathy remains unsatisfactory. Medical measures, including formalin installation, 5 topical sucralfate, 6 5-amino salicylic acid enemas, 7 short chain fatty acids 8 and anti- oxidants such as vitamin E, 9 have been used with limited success. Surgical management is associated with high morbidity and mortality. 10 Endoscopic therapy using modalities such as the heater probe, 11 neodymium : yttrium–aluminium–garnet (Nd:YAG) laser, 12,13 potassium titanyl phosphate (KTP) laser 14 and bipolar electrocoagulation 15 has been reported to be of some benefit, but at the expense of a high level of com- plications. 16 Argon plasma coagulation (APC) is an innovative, no- touch electrocoagulation technique used in the treat- ment of hemorrhagic digestive malformations. 17 In con- trast to lasers, the potential advantages of this technique