UCTN – Unusual cases and technical notes E375

Rectal band ligation for treatment of extensive chronic hemorrhagic radiation

Chronic radiation proctitis is an infre- radiation proctitis (●" Fig.1c) and the quent of pelvic radiother- topical therapy was discontinued. apy, occurring in 5%–20 % of patients [1]. To date there are no data or reports in the (APC) is the literature regarding the use of band liga- preferred endoscopic therapy for treat- tion for the treatment of chronic hemor- ment of chronic radiation proctitis and is rhagic radiation proctitis. In our experi- considered effective and well tolerated. ence, RBL is an effective, painless, safe, A 74-year-old man with a history of radi- and rapid treatment for this disease, cal prostatectomy and subsequent radio- which we believe could be used as the therapy 3 years previously was brought first approach in extensive chronic to the emergency room of our center be- hemorrhagic radiation proctitis. cause of proctorrhagia for 3 days. The patient underwent , Endoscopy_UCTN_Code_TTT_1AQ_2AZ which showed sigmoid diverticular dis- ease and chronic hemorrhagic radiation Competing interests: None proctitis involving the distal 4cm of the . The patient underwent two treat- ments with APC separated from each B. Mangiavillano, E. Morandi, other by 20 days. These resulted in the P. Viaggi, M. Arena, E. Masci creation of a large ulcer that involved Gastrointestinal Endoscopy, Azienda one-third of the wall, but no clinical im- Ospedaliera San Paolo, University of Milan, ●" provement ( Fig.1a). In view of the Milan, Italy absence of improvement and continued episodes of proctorrhagia, the large extent of the disease, and the possibility that at References least five more APC treatments would be 1 Rustagi T, Mashimo H. Endoscopic manage- ment of chronic radiation proctitis. World J needed, we decided to treat the patient Gastroenterol 2011; 17: 4554 –4562 with rectal band ligation (RBL) instead. RBL was performed with a standard gastroscope and a standard endoscopic Bibliography esophageal variceal ligation kit in two DOI http://dx.doi.org/ 10.1055/s-0032-1310062 procedures separated by a period of 20 Endoscopy 2012; 44: E375 days. The patient was not sedated during © Georg Thieme Verlag KG the procedures. Three bands were placed Stuttgart · New York in the first session and two during the ISSN 0013-726X Fig. 1 Appearances during lower gastrointes- second session (●" Fig.1b). RBL was well tinal endoscopy showing: a the area of chronic tolerated: the patient reported no pain Corresponding author hemorrhagic radiation proctitis after argon during the procedures or in the subse- B. Mangiavillano, MD plasma coagulation (APC) therapy; b rectal quent days. Throughout the treatment Gastrointestinal Endoscopy band ligation (RBL) being performed; c com- period the patient underwent topical San Paolo University Hospital plete resolution of the chronic hemorrhagic This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. therapy with mesalazine. A lower gastro- Via A. di Rudinì 8 radiation proctitis after the two RBL proce- intestinal endoscopy 45 days after the 20142 Milano dures. completion of treatment showed no evi- Italy Fax: +39-02-81844647 dence of ongoing chronic hemorrhagic [email protected]

Mangiavillano B et al. Rectal band ligation for chronic hemorrhagic radiation proctitis… Endoscopy 2012; 44: E375