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Abstract
Background Multiple modalities, such as medical, Argon plasma Coagulation (APC), Formalin, and Hyperbaric Oxygen therapy, are available for the treatment of radiation proctitis. APC and sucralfate enema are commonly used alone or in combination. However, the literature comparing the two is lacking. The aim of the study was to compare the combination therapy of Argan plasma Coagulation plus sucralfate enema with Argan plasma coagulation.
Methods Patients with bleeding Per rectum post-radiation therapy were randomized into two groups. Radiation colitis was diagnosed on the endoscopy. The endoscopic severity was classified into four grades: I, II, III, and IV, as per our own classification (IDDF2024-ABS-0108 Table 1). Only Groups II and III were further included in the study. Group A received Argon Plasma Coagulation (APC) plus Sucralfate Enema and Group B received only APC. Patients in group A received Sucralfate enema twice daily for 8 weeks and underwent APC sessions every 2 weeks. The Patients in Group B underwent APC sessions only. Patients were followed each week during treatment duration and then every month on the phone or clinic for a period of two years. The response was considered as the resolution of symptoms and stabilization of haemoglobin.
Results 300 were enrolled in the study. 150 in group A underwent APC plus twice daily Sucralfate Enema and 150 in Group B underwent APC only (IDDF2024-ABS-0108 Table 2). Group A and B patients underwent a mean of 2 sessions of APC (IQR 1 to 4) and 3 sessions (IQR 2 to 6 sessions), p=0.03 (IDDF2024-ABS-0108 Figure 1). Among Groups A and B, the response rate was 85.33% and 77.33%, respectively (p=0.02). 2% and 5.33% of the patients in Groups A and B required Blood transfusions during the treatment (P=0.03). Complications in the form of stricture and perforation were seen in 1.33% and 0.66% of patients in group A and 2.66 and 1.33% in group B patients. (P=0.2). Recurrence was seen in 10.66% and 19.33% of patients during two years of follow-up (p=0.04) (IDDF2024-ABS-0108 Figure 2).
Conclusions Combination of Argan plasma Coagulation plus Sucralfate enema therapy is more effective and need less sessions than Aragan plasma coagulation alone in Moderate to severe Radiation proctitis.