The interpretation of 2019 ASGE guideline on the role of endoscopy for bleeding from chronic radiation proctopathy_Chinese Journal of Evidence-Based Medicine

Authors：

HUANG Zhiquan ,  ZHU Liang

Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, P.R.China;

Corresponding author：

ZHU Liang, Email: 89493075@qq.com

Keywords：

Chronic radiation proctopathy; Bleeding; Endoscopic therapy; Adverse events; Guideline interpretation

DOI：

10.7507/1672-2531.202001046

Video：

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Abstract Full text Figures/Tables Video References Cited by

Radiation proctopathy, which can be categorized as acute and chronic, is defined as the radiation damage to the rectum caused by radiation therapy in patients with pelvic malignancies. Chronic radiation proctopathy can cause complications such as rectal bleeding, which severely affects patients’ quality of life. At present, endoscopic therapy has become the primary method for diagnosis and treatment of bleeding from chronic radiation proctopathy. In October 2019, the American Society for Gastrointestinal Endoscopy (ASGE) published "ASGE guideline on the role of endoscopy for bleeding from chronic radiation". The guideline described the effectiveness and safety of different endoscopic therapies such as argon plasma coagulation, bipolar electrocoagulation, heater probe, radiofrequency ablation, cryoablation, etc. in the treatment of bleeding from chronic radiation. This paper interprets it to provide references for clinicians in the treatment of bleeding from chronic radiation.

Citation： HUANG Zhiquan, ZHU Liang. The interpretation of 2019 ASGE guideline on the role of endoscopy for bleeding from chronic radiation proctopathy. Chinese Journal of Evidence-Based Medicine, 2020, 20(7): 749-752. doi: 10.7507/1672-2531.202001046 Copy

1.	Denton A, Forbes A, Andreyev J, et al. Non-surgical interventions for late radiation proctopathy in patients who have received radical radiotherapy to the pelvis. Cochrane Database Syst Rev, 2002, (1): CD003455.
2.	Lee JK, Agrawal D, Thosani N, et al. ASGE guideline on the role of endoscopy for bleeding from chronic radiation proctopathy. Gastrointest Endosc, 2019, 90(2): 171-182.
3.	Guyatt GH, Oxman AD, Vist GE, et al. GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 2008, 336(7650): 924-926.
4.	Alfadhli AA, Alazmi WM, Ponich T, et al. Efficacy of argon plasma coagulation compared to topical formalin application for chronic radiation proctopathy. Can J Gastroenterol, 2008, 22(2): 129-132.
5.	Yeoh E, Tam W, Schoeman M, et al. Argon plasma coagulation therapy versus topical formalin for intractable rectal bleeding and anorectal dysfunction after radiation therapy for prostate carcinoma. Int J Radiat Oncol Biol Phys, 2013, 87(5): 954-959.
6.	Lenz L, Tafarel J, Correia L, et al. Comparative study of bipolar eletrocoagulation versus argon plasma coagulation for rectal bleeding due to chronic radiation coloproctopathy. Endoscopy, 2011, 43(8): 697-701.
7.	Denton AS, Clarke NW, Maher EJ. Non-surgical interventions for late radiation cystitis in patients who have received radical radiotherapy to the pelvis. Cochrane Database Syst Rev, 2002, (3): CD001773.
8.	Ben-Soussan E, Antonietti M, Savoye G, et al. Argon plasma coagulation in the treatment of hemorrhagic radiation proctitis is efficient but requires a perfect colonic cleansing to be safe. Eur J Gastroenterol Hepatol, 2004, 16(12): 1315-1318.
9.	Karamanolis G, Triantafyllou K, Tsiamoulos Z, et al. Argon plasma coagulation has a long-lasting therapeutic effect in patients with chronic radiation proctitis. Endoscopy, 2009, 41(6): 529-531.
10.	Castro JM, Hernández GA, Sobrino CS, et al. Bipolar electrocoagulation in patients with persistent hemorrhage secondary to second degree postradiation proctopathy. Rev Gastroenterol Mex, 2003, 68(3): 207-214.
11.	Jensen DM, Machicado GA, Cheng S, et al. A randomized prospective study of endoscopic bipolar electrocoagulation and heater probe treatment of chronic rectal bleeding from radiation telangiectasia. Gastrointest Endosc, 1997, 45(1): 20-25.
12.	Sharma V, Sharma R, Mangal D. A randomized prospective study of endoscopic bipolar heater probe treatment of chronic rectal bleeding from radiation proctopathy. Ann Oncol, 2013, 24(suppl 4): iv38-121.
13.	Fuentes D, Monserat R, Isern AM, et al. Colitis due to radiation: endoscopic management with heat probe. GEN, 1993, 47(3): 165-167.
14.	Dray X, Repici A, Gonzalez P, et al. Radiofrequency ablation for the treatment of gastric antral vascular ectasia. Endoscopy, 2014, 46(11): 963-969.
15.	Rustagi T, Corbett FS, Mashimo H. Treatment of chronic radiation proctopathy with radiofrequency ablation (with video). Gastrointest Endosc, 2015, 81(2): 428-436.
16.	Shahbaz O, Tadros M, Chaletsky DM. Radiofrequency ablation for the management of radiation proctopathy: an effective and safe treatment modality[abstract]. Gastrointest Endosc, 2014, 79(5): AB459-460.
17.	Hou JK, Abudayyeh S, Shaib Y. Treatment of chronic radiation proctitis with cryoablation. Gastrointest Endosc, 2011, 73(2): 383-389.
18.	Kantsevoy SV, Cruz-Correa MR, Vaughn CA, et al. Endoscopic cryotherapy for the treatment of bleeding mucosal vascular lesions of the GI tract: a pilot study. Gastrointest Endosc, 2003, 57(3): 403-406.

1. Denton A, Forbes A, Andreyev J, et al. Non-surgical interventions for late radiation proctopathy in patients who have received radical radiotherapy to the pelvis. Cochrane Database Syst Rev, 2002, (1): CD003455.
2. Lee JK, Agrawal D, Thosani N, et al. ASGE guideline on the role of endoscopy for bleeding from chronic radiation proctopathy. Gastrointest Endosc, 2019, 90(2): 171-182.
3. Guyatt GH, Oxman AD, Vist GE, et al. GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 2008, 336(7650): 924-926.
4. Alfadhli AA, Alazmi WM, Ponich T, et al. Efficacy of argon plasma coagulation compared to topical formalin application for chronic radiation proctopathy. Can J Gastroenterol, 2008, 22(2): 129-132.
5. Yeoh E, Tam W, Schoeman M, et al. Argon plasma coagulation therapy versus topical formalin for intractable rectal bleeding and anorectal dysfunction after radiation therapy for prostate carcinoma. Int J Radiat Oncol Biol Phys, 2013, 87(5): 954-959.
6. Lenz L, Tafarel J, Correia L, et al. Comparative study of bipolar eletrocoagulation versus argon plasma coagulation for rectal bleeding due to chronic radiation coloproctopathy. Endoscopy, 2011, 43(8): 697-701.
7. Denton AS, Clarke NW, Maher EJ. Non-surgical interventions for late radiation cystitis in patients who have received radical radiotherapy to the pelvis. Cochrane Database Syst Rev, 2002, (3): CD001773.
8. Ben-Soussan E, Antonietti M, Savoye G, et al. Argon plasma coagulation in the treatment of hemorrhagic radiation proctitis is efficient but requires a perfect colonic cleansing to be safe. Eur J Gastroenterol Hepatol, 2004, 16(12): 1315-1318.
9. Karamanolis G, Triantafyllou K, Tsiamoulos Z, et al. Argon plasma coagulation has a long-lasting therapeutic effect in patients with chronic radiation proctitis. Endoscopy, 2009, 41(6): 529-531.
10. Castro JM, Hernández GA, Sobrino CS, et al. Bipolar electrocoagulation in patients with persistent hemorrhage secondary to second degree postradiation proctopathy. Rev Gastroenterol Mex, 2003, 68(3): 207-214.
11. Jensen DM, Machicado GA, Cheng S, et al. A randomized prospective study of endoscopic bipolar electrocoagulation and heater probe treatment of chronic rectal bleeding from radiation telangiectasia. Gastrointest Endosc, 1997, 45(1): 20-25.
12. Sharma V, Sharma R, Mangal D. A randomized prospective study of endoscopic bipolar heater probe treatment of chronic rectal bleeding from radiation proctopathy. Ann Oncol, 2013, 24(suppl 4): iv38-121.
13. Fuentes D, Monserat R, Isern AM, et al. Colitis due to radiation: endoscopic management with heat probe. GEN, 1993, 47(3): 165-167.
14. Dray X, Repici A, Gonzalez P, et al. Radiofrequency ablation for the treatment of gastric antral vascular ectasia. Endoscopy, 2014, 46(11): 963-969.
15. Rustagi T, Corbett FS, Mashimo H. Treatment of chronic radiation proctopathy with radiofrequency ablation (with video). Gastrointest Endosc, 2015, 81(2): 428-436.
16. Shahbaz O, Tadros M, Chaletsky DM. Radiofrequency ablation for the management of radiation proctopathy: an effective and safe treatment modality[abstract]. Gastrointest Endosc, 2014, 79(5): AB459-460.
17. Hou JK, Abudayyeh S, Shaib Y. Treatment of chronic radiation proctitis with cryoablation. Gastrointest Endosc, 2011, 73(2): 383-389.
18. Kantsevoy SV, Cruz-Correa MR, Vaughn CA, et al. Endoscopic cryotherapy for the treatment of bleeding mucosal vascular lesions of the GI tract: a pilot study. Gastrointest Endosc, 2003, 57(3): 403-406.

Chinese Journal of Evidence-Based Medicine

The interpretation of 2019 ASGE guideline on the role of endoscopy for bleeding from chronic radiation proctopathy

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