Estudo prospectivo randomizado do tratamento endoscópico da coloproctopatia actínica crônica hemorrágica: eletrocauterização com plasma de argônio versus bipolar

• Ano de defesa: 2010
• Autor(a) principal: Lenz Tolentino, Luciano Henrique [UNIFESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Argônio; Bipolar; Eletrocauterização; Endoscopia; Coloproctopatia actínica; Cauterização; Proctite/complicações; Radioterapia/efeitos adversos; Argon; Electrocoagulation; Endoscopy; Cautery; Proctitis/complications; Radiotherapy/adverse effects
• Link de acesso: http://repositorio.unifesp.br/handle/11600/9594

Introduction: Chronic radiation coloproctopathy (CRCP) is a well-recognized complication of radiotherapy. Rectal bleeding is the most common symptom of radiation injury and the optimal endoscopic treatment of bleeding due to CRCP is still controversial. Aim: To compare the efficacy and safety of bipolar eletrocauterization (BEC) and argon plasma eletrocauterization (APE) in the management of bleeding from CRCP. Methods: Thirty patients with active bleeding from telangiectasias were enrolled, randomized into two groups (15 BEC and 15 APE) and classified according to Saunders score. Power settings were 50 W for BEC and 40 W for APE. Initial treatment was performed after a complete colonoscopy to rule out synchronous lesions and follow-up was performed with flexible sigmoidoscopies. Success was defined as eradication of all telangiectasias. Failure was defined whenever more than seven sessions or other therapies were necessary for treatment of bleeding. Complications were divided into three different groups: sensory (anal pain, abdominal pain and/or fever), hemorrhagic (worsening of bleeding during treatment, bleeding from ulcers) and anatomic/motor (tapered feces, stenosis and/or pseudopolyps). Results: Mean age was 67.4 years (range 33-82), with 14 women and 16 men. There was no significant difference regarding the number of sessions in both groups (p = 0.313). There were no significant differences regarding sensory (p = 0.245) hemorrhagic (p = 0.169) or anatomic/motor (p = 0.700) complications between both groups. However, the overall complication rate was significantly higher in EB group (p = 0.020). Only one failure was observed in each group (p = 1.000). There was also no significant difference regarding relapse (p = 1.000) Conclusions: BEC and APE are equally effective in patients with bleeding telangiectasias from CRCP. Nevertheless, APE is safer than EB.