Introduction Refractory rectal bleeding has been reported to occur in 2 to 51% of patients who previously received pelvic radiotherapy. It can significantly impair quality of life but there is no standard therapy for radiation induced rectal bleeding. Use of intra-rectal formalin has been described but there are no standardised protocols. Aim: To assess short and long-term outcomes prospectively after intra-rectal formalin delivered endoscopically in unsedated patients for radiation-induced rectal bleeding.

Method Patients with significant rectal bleeding due to a radiation proctopathy were treated with instillation of 5% formalin into the rectum through a flexible endoscope for 3 min followed by irrigation. This was repeated every 6–8 weeks, if there was no response, up to a maximum of 4 times.

Results Forty-three patients received intra-rectal formalin therapy: 14 (33%) required one session to alleviate bleeding; 17 (40%) required two; 10 (23%) received three; and 2 (4%) received four. Median follow up was 29 months (range 4–67). Using patient recorded outcome measures (PROM), there was a significant reduction in nuisance from rectal bleeding after treatment (P< 0.0001) with a significant reduction in frequency in bleeding in 88% of cases. Five patients required an alternative treatment modality due to failure of formalin. Seven patients had minor side effects which resolved in the endoscopy department. There were no serious adverse effects and no long-term consequences related to formalin.

Conclusion Administering intra-rectal formalin endoscopically is effective, safe, well tolerated, technically simple and can be done in an outpatient setting with few long-term complications.

Disclosure of interest None Declared.

Reference

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