RESUMEN
OBJECTIVE: To evaluate the efficacy, safety and medium-/long-term clinical course of patients undergoing endoscopic treatment with argon plasma coagulation for hemorrhagic radiation proctopathy. DESIGN: Descriptive, retrospective study with medium- and long-term follow-up. PATIENTS, MATERIAL AND METHODS: Ten patients were treated with argon plasma coagulation for hemorrhagic radiation proctopathy between July 1998 and February 2003. Inclusion criteria were: evidence of chronic rectal bleeding, consistent endoscopic findings, and absence of any other cause of hematochezia after a comprehensive ano-rectal examination and complete colonoscopy. The equipment used was a standard colonoscope, an argon delivery unit, an argon plasma coagulation probe 1.5 mm in internal diameter, and a high-frequency electrosurgical generator. Consecutive treatment sessions were programmed whenever it was considered necessary until all mucosal lesions had been treated. Clinical and evolutive follow-up was performed with a focus on tolerance, efficacy, and potential argon plasma coagulation-related complications. Data were updated by personal or telephonic interview. RESULTS: In all patients, chronic rectal bleeding stopped after the last treatment session. The mean number of treatment sessions to stop symptoms was 1.7. Mean follow-up was 31.1 months. All sessions were well tolerated, similarly to standard rectoscopy. In one case a recurrence of rectal bleeding was observed four months later, which required two repeat sessions. Four patients were anemic at inclusion. Three of them reported a resolved anemia at the end of the study. No delayed argon plasma coagulation-related complications such us ulcers or strictures were seen. CONCLUSIONS: Argon plasma coagulation appears to be a useful, effective and safe treatment for rectal bleeding resulting from chronic radiation proctitis when compared to standard medical and endoscopic treatments. These successful outcomes seem to persist even after long-term follow-up.
Asunto(s)
Hemorragia Gastrointestinal/cirugía , Coagulación con Láser/métodos , Proctitis/cirugía , Traumatismos por Radiación/cirugía , Adenocarcinoma/radioterapia , Anciano , Argón , Femenino , Hemorragia Gastrointestinal/etiología , Hemostasis Endoscópica/métodos , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Pélvicas/radioterapia , Proctitis/etiología , Traumatismos por Radiación/complicaciones , Radioterapia/efectos adversos , Estudios Retrospectivos , Seguridad , Resultado del TratamientoRESUMEN
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Asunto(s)
Anciano , Masculino , Humanos , Insuficiencia Hepática , Adenocarcinoma , Antagonistas de Andrógenos , Flutamida , Neoplasias de la PróstataRESUMEN
La isquemia colónica es una de las patologías que más frecuentemente afectan al colon en ancianos, aunque puede también aparecer en personas jóvenes. El sigma y el colon izquierdo son las zonas que con más frecuencia se afectan. Aunque en la mayoría de los casos no se identifica una causa específica de isquemia, en otras ocasiones existe una causa desencadenante. Presentamos el caso de una enferma que desarrolló una colitis isquémica asociada a déficit congénito de antitrombina III (AU)