Ligadura elástica múltipla no tratamento da proctopatia actínica hemorrágica crônica: estudo piloto

Abstract

BACKGROUND. Radiation-induced proctopathy occurs in up to 20% of patients who receive radiation for pelvic malignancies. Among all possible clinical manifestations, rectal bleeding is the most common, and its management remains controversial. Many endoscopic techniques are available but none can yet be considered ideal. AIM. A pilot study to evaluate the safety and feasibility of endoscopic band ligation (EBL) for the treatment of severe presentations of chronic radiation-induced rectal bleeding PATIENTS AND METHODS. After excluding patients with mild bleeding, anorectal stenosis, ulceration or fistulae, eight patients (seven men, mean age of 65 years) were studied. The endoscopic band ligation was performed by using the Speedband Superview Super7 multiple band ligator (Boston Scientific) and a gastroscope. The negative pressure of suction ranged from 300 mmHg to 400 mmHg. A clinical score (Chutkan) and hemoglobin level were evaluated 30, 60 and 180 days after the first session of EBL. New sessions of EBL were made in case of persistence of rectal bleeding or decreasing of hemoglobin levels. RESULTS. A total of 11 sessions of EBL were performed (mean of 1.38/patient). Only in three patients the second session was feasible. In none, the third session was possible. The cicatricial tissue developed after the first session of EBL was the main cause of suctioning failure. Two patients did not improved and another modality of treatment (argon plasma coagulation) was offered. The mean level of hemoglobin from the patients with a 180 days follow-up raised from 10.36g/dL to 12.6g/dL [p < 0,05 IC 95% (-3,878; -0,642)]. Chutkans Score was 3.38 before the treatment, reaching 2.0 within 30 days and 0.6 after 180 days. Any major complication occurred.CONCLUSION. In patients with the severe presentation of chronic radiation-induced rectal bleeding, EBL was feasible and controlled the hemoglobin level in six among eight patients (75%) in at most two sessions. No major complications resulted and EBL did not avoided the use of another technique in cases of failure.