This protocol addresses chronic radiation proctitis (CRP), Grade 1. Establishing the grade of CRP is a key step in guiding clinical decision-making and determining when escalation of care is appropriate.
The prior treatment line used formalin (formaldehyde 4%–10%) applied topically to the rectal mucosa via rigid proctoscopy, argon plasma coagulation, or neodymium-doped yttrium aluminum garnet (Nd:YAG) laser.
Escalation to this protocol is triggered when that approach has not achieved its target: cessation or substantial decrease in rectal bleeding (hemostasis).
When endoscopic and topical management has been exhausted without achieving hemostasis, surgical intervention becomes the next consideration. The full protocol specifies which surgical options apply, in what circumstances, and how they are selected.
DOI: 10.5946/ce.2020.288
Chronic radiation proctitis (CRP) · Establish the grade of CRP · Grade 1
Surgery is reserved for patients who fail to show improvement in their symptoms following medical or endoscopic management or in patients with severe complications of RP, such as strictures leading to bowel obstruction, perforations, or fistulas.
In severe cases, proctectomy may become necessary; however, there is no universally approved first-line approach for the surgery.
Diversion of the bowel segment in the form of ileostomy or colostomy has demonstrated significant improvement in the quality of life without further surgical interventions.
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