Radiation Enteritis and Proctitis Guidelines

Updated: Nov 06, 2019
  • Author: Neelu Pal, MD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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ASCRS Guidelines for Chronic Radiation Proctitis

In October 2018, the American Society of Colon and Rectal Surgeons (ASCRS) issued clinical practice guidelines for the treatment of chronic radiation proctitis (CRP). [21] Recommendations included the following:

  • A disease-specific history and physical examination should be performed, emphasizing the degree and duration of bleeding.
  • Prophylactic measures, such as pedicled omental flap and tissue expander implant, have been described to decrease the incidence of radiation proctitis. These techniques are insufficiently evaluated and are not routinely recommended.
  • Formalin application is an effective treatment for bleeding in patients with CRP.
  • Sucralfate retention enemas are a moderately effective treatment for rectal bleeding resulting from CRP. 
  • Short-chain fatty acid (SFCA) enemas are not effective in preventing or treating chronic hemorrhagic radiation proctitis and are not recommended.
  • Alternative treatments such as mesalamine, ozonetherapy, and metronidazole have not been adequately evaluated in treating radiation proctitis and are not recommended.
  • Endoscopic argon beam plasma coagulation (APC) is a safe and effective treatment for rectal bleeding induced by CRP.
  • Hyperbaric oxygen therapy is an effective treatment modality for reducing bleeding in patients with CRP.
  • Endoscopic bipolar electrocoagulation, radiofrequency ablation (RFA), neodymium:yttrium-aluminum-garnet (Nd:YAG) laser, and cryotherapy are alternative treatments of rectal bleeding from CRP that have been insufficiently evaluated and are thus not recommended.