The American Society of Colon and Rectal Surgeons (ASCRS) has released its Clinical Practice Guidelines for treatment of Chronic Radiation Proctitis. They have appeared in Journal Diseases of the Colon & Rectum.
These guidelines are dedicated to ensuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. These guidelines are inclusive, not prescriptive, and are intended for the use of all practitioners, healthcare workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines.
Major Recommendations are –
Evaluation of Chronic Radiation Proctitis
- A disease-specific history and physical examination should be performed, emphasizing the degree and duration of bleeding.
- Prophylactic measures, such as pedicled omental flap and tissue expander implant, have been described to decrease the incidence of radiation proctitis. These techniques are insufficiently evaluated and are not routinely recommended.
- Formalin application is an effective treatment for bleeding in patients with CRP.
- Sucralfate retention enemas are a moderately effective treatment for rectal bleeding resulting from CRP.
- Short chain fatty acid enemas are not effective in preventing or treating chronic hemorrhagic radiation proctitis and are not recommended.
- Alternative treatments such as mesalamine, ozone therapy, and metronidazole have not been adequately evaluated in treating radiation proctitis and are not recommended.
- Endoscopic argon beam plasma coagulation is a safe and effective treatment for rectal bleeding induced by CRP.
- Hyperbaric oxygen therapy is an effective treatment modality to reduce bleeding in patients with CRP.
- Endoscopic bipolar electrocoagulation, radiofrequency ablation, Nd-YAG laser, and cryotherapy are alternative treatments of rectal bleeding from CRP that have been insufficiently evaluated and are thus not recommended.
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