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Radiation proctitis

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of radiation proctitis are prepared by our editorial team based on guidelines from the Multinational Association of Supportive Care in Cancer (MASCC/ISOO 2020), the American Society for Gastrointestinal Endoscopy (ASGE 2019), the American Society of Colon and Rectal Surgeons (ASCRS 2018), and the European Society of Medical Oncology (ESMO 2015). ...
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Diagnostic investigations

Clinical examination: as per ASCRS 2018 guidelines, elicit a disease-specific history and perform a physical examination, emphasizing the degree and duration of bleeding in patients with suspected radiation proctitis.
B
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Medical management

Sucralfate enema: as per ASCRS 2018 guidelines, consider administering sucralfate retention enemas for the treatment of bleeding in patients with chronic radiation proctitis.
B

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  • Short-chain fatty acid enema

  • Topical formalin

  • Agents with no evidence for benefit

Therapeutic procedures

Endoscopic thermal procedures
As per ASGE 2019 guidelines:
Consider offering the following procedures for the treatment of bleeding in patients with chronic radiation proctitis:
argon plasma coagulation
bipolar electrocoagulation
heater probe, and radiofrequency ablation
C
Insufficient evidence to recommend a specific endoscopic modality over another.
I

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  • Cryoablation

  • Hyperbaric oxygen therapy

  • Ozone therapy

Preventative measures

Amifostine: as per ESMO 2015 guidelines, administer IV amifostine at a dose of ≥ 340 mg/m² for the prevention of radiation proctitis in patients receiving radiation therapy.
B

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  • Misoprostol

  • Preventive surgical adjuncts