ND-YAG LASER TREATMENT FOR BLEEDING FROM RADIATION PROCTITIS

Background and study aims: Chronic radiation proctitis is a serious co mplication of radiotherapy to the pelvis. It can lead to severe blood loss, and responds poorly to surgery or local drug therapy, This study looks at which of ge the patients affected may benefit from endoscopi c treatment with Nd:YAG laser. Patients and methods: Nine patients who had previously undergone radiotherapy for pelvic malignancy a median of 14 months (range 4-43 months) before I ectal bleeding started were included, Endoscopic Nd:YAG laser treatment commenced a median of four months (range 2-13 months) after the onset of blood loss, and was rep eated monthly until bleeding stopped, Bleeding and transfusion require ments were documented before, during, and after a course of laser trea tment. Results: Patients received an average of three laser treatments (range 1-5). Six had received transfusions prior to referral, the ave rage requirement being 1.3 units per patient month. Only one patient r equired transfusion after completion of treatment, during an average f ollow-up of 24 months. Bleeding was reduced to occasional spotting in sis cases, There were no treatment-related complications. Two of the m ost severely affected patients died within three months of treatment, due to recurrence of their underlying malignancy. Conclusion: Endoscop ic Nd:YAG laser treatment is safe and effective for patients with mild to moderate bleeding from radiation proctitis.