Using radiofrequency ablation for conventional endoscopic treatment refractory bleeding from radiation proctitis: A single center cohort

The treatment of bleeding in patients with radiation proctitis is clinically challenging, with no effective management strategy currently available for controlling bleeding refractory to conventional medications and endoscopic hemostatic tools. Bleeding has been controlled in a small number of patients using radiofrequency ablation (RFA) in western countries. However, there is limited experience with RFA treatment in Asia. Therefore, the aim of our study was to report on our treatment of refractory bleeding in three patients with radiation proctitis using RFA. All three patients in our case series were referred to Chia‐yi Christian Hospital for RFA treatment. Patients' medical records were reviewed to confirm persistent bleeding after treatment with medical and conventional endoscopy. A pre‐RFA colonoscopy was performed to confirm the severity of radiation proctitis and to exclude other causes of bleeding. RFA was performed using a Halo90 system, with an energy setting of 12 J/cm 2 , applied twice to every area of bleeding on the mucosa per treatment session. All patients received one RFA session, with follow‐up treatment as needed. Clinical symptoms, diarrhea, bleeding, tenesmus, and transfusion dependence were recorded. Our study included one patient with uterine cancer and two patients with prostate cancer, with all patients having severe symptoms of radiation proctitis, with more than six bloody stool passages per day and all were transfusion‐dependent. All patients had failed to respond to medication treatment and endoscopic argon plasma coagulation. Two patients had also undergone hyperbaric oxygen treatment prior to RFA, with no response. At the time of RFA treatment, bleeding had persisted for eight, six, and four months among the three patients. Overt and persistent bleeding from the telangiectasia was identified by colonoscopy in all three patients. Post‐RFA treatment, complete or near‐complete control of the bleeding was obtained during the follow‐up period, with no patients requiring further transfusion. No RFA‐associated complications were noted, including stricture or perforation. RFA can safely and effectively be used to control bleeding from radiation proctitis that has been refractory to conventional endoscopic hemostatic tools. Further accumulation of more evidence is warranted.