Treatment of Chronic Radiation Proctitis

Publication Date: October 1, 2018
Last Updated: March 14, 2022

Recommendations

Evaluation of Chronic Radiation Proctitis

A disease-specific history and physical examination should be performed, emphasizing the degree and duration of bleeding. (1C)
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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. (1C)
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Medical Treatments

Formalin application is an effective treatment for bleeding in patients with CRP. (1B)
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Sucralfate retention enemas are a moderately effective treatment for rectal bleeding resulting from CRP. (1C)
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Short chain fatty acid enemas are not effective in preventing or treating chronic hemorrhagic radiation proctitis and are not recommended. (1B)
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Alternative treatments such as mesalamine, ozone therapy, and metronidazole have not been adequately evaluated in treating radiation proctitis and are not recommended. (1C)
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Interventional Treatments

Endoscopic argon beam plasma coagulation is a safe and effective treatment for rectal bleeding induced by CRP. (1B)
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Hyperbaric oxygen therapy is an effective treatment modality to reduce bleeding in patients with CRP. (1B)
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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. (1C)
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Recommendation Grading

Overview

Title

Treatment of Chronic Radiation Proctitis

Authoring Organization

American Society of Colon and Rectal Surgeons

Publication Month/Year

October 1, 2018

Last Updated Month/Year

October 1, 2024

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Hospital, Outpatient, Radiology services, Operating and recovery room

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Treatment, Management

Diseases/Conditions (MeSH)

D011349 - Proctitis, D000071077 - Surgical Oncology

Keywords

hematochezia, Chronic Radiation Proctitis, tenesmus

Source Citation

Paquette, Ian M. M.D.1; Vogel, Jon D. M.D.2; Abbas, Maher A. M.D.3; Feingold, Daniel L. M.D.4; Steele, Scott R. M.D., M.B.A.5; On behalf of the Clinical Practice Guidelines Committee of The American Society of Colon and Rectal Surgeons The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Chronic Radiation Proctitis, Diseases of the Colon & Rectum: October 2018 - Volume 61 - Issue 10 - p 1135-1140 doi: 10.1097/DCR.0000000000001209
 

Methodology

Number of Source Documents
56
Literature Search Start Date
January 1, 1990
Literature Search End Date
October 26, 2017