Hemorrhoid management in patients with radiation proctitis

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• 作者：Melinda Hawkins (1)
  Richard Billingham (2)
  Amir Bastawrous (2)
  
• 关键词：Sucralfate ; Hemorrhoids ; Radiation proctitis ; Rectal bleeding ; Hemorrhoidectomy ; Sclerotherapy ; Rubber band ligation
• 刊名：International Journal of Colorectal Disease
• 出版年：2012
• 出版时间：December 2012
• 年：2012
• 卷：27
• 期：12
• 页码：1673-1677
• 全文大小：153KB
• 参考文献：1. Raman R (2007) Two percent formalin retention enemas for hemorrhagic radiation proctitis: a preliminary report. Dis Colon Rectum 50:1- CrossRef
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• 作者单位：Melinda Hawkins (1)
  Richard Billingham (2)
  Amir Bastawrous (2)
  
  1. Department of Surgery, Swedish Medical Center, 747 Broadway Ave, Suite WW-731, Seattle, WA, 98122, USA
  2. FACS, Swedish Colon Rectal Clinic, 1101 Madison St, Suite 500, Seattle, WA, 98104-1306, USA
  
• ISSN：1432-1262

文摘

Purpose Management of rectal bleeding in patients with radiation proctitis presents a conundrum for practitioners. Surgeons are appropriately concerned about using conventional methods of treatment in these patients, such as cautery for bleeding areas in the rectum, rubber band ligation, or excision of internal and/or external hemorrhoids, for fear of poor healing and possible exacerbation of the original problem. Few randomized controlled trials are available on the treatment of radiation proctitis alone, and no literature exists pertaining to the management of symptomatic hemorrhoids in the radiated patient. Methods In the absence of observational studies, the authors created an email survey to distribute to the membership of the American Society of Colon and Rectal Surgeons in order to try to identify current management practices for radiation proctitis and for the treatment of their symptomatic hemorrhoids. Results Of the 327 respondents, 85?% favored the use of topical formalin to treat radiation proctitis, while 42?% additionally used argon plasma coagulation. Only 25?% of practitioners report using sucralfate, though existing data on this therapy are promising. Regarding the management of hemorrhoids in patients with a history of rectal irradiation, 55?% of respondents hoped treatment of radiation proctitis alone would solve the problem. Forty-three percent reported using rubber band ligation, 30?% using hemorrhoidectomy, and 18?% using sclerotherapy. Conclusions While most respondents treated radiation proctitis alone in patients with symptomatic hemorrhoids, many also felt rubber band ligation, hemorrhoidectomy, and sclerotherapy are safe and effective alternative therapies in this population.