Mustafa YAKUT, Kubilay ÇINAR, Mehmet BEKTAŞ, Arzu YUSİFOVA, Selim KARAYALÇIN, Ali ÖZDEN

Hemorajik radyasyon proktiti hastalarında rektal kanama kontrolünde endoskopik argon plazma koagülasyon tedavisinin etkinliğinin ve güvenirliliğinin retrospektif analizi

Giriş ve Amaç: Pelvik radyoterapiden sonra nisbeten geç dönemde meydana gelen hemorajik radyasyon proktiti sıklıkla medikal ve cerrahi tedavilere yanıtsızdır. Çalışmamızda 5 ASA enema tedavisine yanıtsız rektal kanama ile seyreden hemorajik radyasyon proktitli hastalarda endoskopik Argon Plazma Koagülasyon tedavisinin rektal kanamayı kontrol etmedeki etkinliği ve işleme bağlı oluşan komplikasyonları değerlendirdik. Gereç ve Yöntem: Eylül 2006 ile Ağustos 2008 tarihleri arasında Ankara Üniversitesi Tıp Fakültesi Gastroenteroloji servisinde takip edilen 10 hemorajik radyasyon rektiti hastası, tıbbi kayıtlardan retrospektif olarak değerlendirildi. Bulgular: Pelvik malignite sonrası radyoterapi alan ve ana semptomu rektal kanama olan ortalama yaşları 69 olan, 8 erkek ve 2 kadın hemorajik radyasyon proktiti hastasına endoskopik olarak Argon Plazma Koagülasyon tedavisi uygulandı. Dört hastada tek Argon Plazma Koagülasyon seansı ile rektal kanama kontrolu sağlandı, 6 hastada ise rektal kanama kontrolu için birden fazla Argon Plazma Koagülasyon seansı ihtiyacı oldu. Hastalara ortalama 2.2 seans Argon Plazma Koagülasyon uygulaması yapıldı. Tüm hastalarda Argon Plazma Koagülasyon ile rektal kanama kontrolu sağlandı. Hiç bir hastada Argon Plazma Koagülasyon uygulamasına bağlı komplikasyon gözlenmedi. Sonuç: Hemorajik radyasyon proktiti, sık transfüzyon ihtiyacı nedeni ile ciddi morbidite nedenidir. Hemorajik radyasyon proktitine bağlı rektal kanama kontrolünde medikal ve cerrahi tedaviler başarısızdır. Endoskopik Argon Plazma Koagülasyon tedavisi hemorajik radyasyon proktitinde yüksek oranda rektal kanama kontrolunu sağlayan oldukça güvenilir bir yöntemdir.

Anahtar Kelimeler:

Argon Plazma Koagülasyon, radyasyon proktiti, rektal kanama

Retrospective analysis of efficacy and safety of endoscopic argon plasma coagulation for the treatment of hemorrhagic radiation proctitis

Background and Aims: Hemorrhagic radiation proctitis, which occurs in a relatively late period after pelvic radiation, usually fails to respond to medical and surgical treatments. In this study, we evaluated the efficiency of argon plasma coagulation in controlling rectal hemorrhage resulting from hemorrhagic radiation proctitis and its complications. Materials and Methods: Between September 2006 and August 2008, we retrospectively evaluated 10 hemorrhagic radiation proctitis patients from the medical records of the Gastroenterology Department of Ankara University. Results: The argon plasma coagulation treatment was applied to 8 male and 2 female patients with rectal bleeding resulting from hemorrhagic radiation proctitis; their average age was 69. The control of rectal bleeding was achieved in one session in four patients; however, more sessions were needed for the other 6 patients. An average of 2.2 sessions were applied to the patients. Rectal bleeding was brought under control in all patients. No complications related to argon plasma coagulation treatment were observed. Conclusions: Hemorrhagic radiation proctitis is a serious cause of morbidity because of the constant need for blood transfusion. Medical and surgical treatments are unsuccessful in controlling rectal hemorrhage resulting from hemorrhagic radiation proctitis. Argon plasma coagulation treatment is a highly effective and safe method in achieving a high level of bleeding control in cases of rectal hemorrhage resulting from hemorrhagic radiation proctitis.

Keywords:

Argon plasma coagulation, radiation proctitis, rectal hemorrhage,

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