Endoscopic and medical therapy for chronic radiation proctopathy: A systematic review

BACKGROUND: Chronic radiation proctopathy is associated with significant morbidity. The effectiveness of endoscopic and medical therapies has not been evaluated. OBJECTIVES: The aim of this study was to conduct a systematic review of the effectiveness of endoscopic and comparative medical therapies for chronic radiation proctopathy. DATA SOURCES: A comprehensive search Medline and PubMed was performed. STUDY SELECTION: A comprehensive literature search was performed for studies of endoscopic and medical therapy for clinical and endoscopic improvement in chronic radiation proctopathy from January 1990 until December 2010. The quality of the overall evidence was rated according to the Grading of Recommendations, Assessment, Development, and Evaluation Working Group. SETTING: Patients in both inpatient and outpatient settings were assessed. PATIENTS: Patients experiencing chronic radiation proctopathy were included. INTERVENTIONS: Patients had undergone medical or endoscopic treatments for chronic radiation proctopathy. MAIN OUTCOME MEASUREMENTS: The primary outcomes measured were the resolution or improvement in symptoms. RESULTS: A total of 39 studies were found, of which 27 evaluated endoscopic therapy and 12 evaluated medical therapy chronic radiation proctopathy. Overall, there is low-level evidence for the effectiveness of endoscopic therapy with argon plasma coagulation in reducing short-term (≤6 weeks) symptoms of chronic radiation proctopathy and insufficient evidence for long-term improvement. There is moderate-level evidence for the use of sucralfate enemas and low-level evidence for use of short-chain fatty acid enemas and hyperbaric oxygen. There is insufficient evidence for other agents: topical formalin, 5-aminosalicylic acid compounds, sulfasalazine, vitamin A, and pentoxifylline. LIMITATIONS: Individual authors were not contacted, and the search was limited to English language journals only. CONCLUSION: Endoscopic treatment with argon plasma coagulation appears effective in the short-term outcome of chronic radiation proctopathy. There is a moderate level of evidence for the use of sucralfate enemas. Large, randomized, placebo-controlled studies evaluating endoscopic and medical therapies for chronic radiation proctopathy are needed.