Risk factors associated to argon plasma coagulation treatment failure in patients with chronic radiation proctopathy.

BACKGROUND: Argon plasma coagulation (APC) is the current endoscopic treatment of choice for patients who develop chronic radiation proctopathy. The aim of this study was to identify risk factors associated with treatment failure.

METHODS: One hundred and ninety-nine patients treated with argon plasma coagulation in a single center were retrospectively analyzed.

RESULTS: Twenty-four (12.06%) patients were classified as APC treatment failures. Requirement of red blood cells transfusion and/or hemoglobin <7 g/dl (OR 12.19, 95% CI 2.78 - 53.45, p<0.001) and severe bleeding frequency (OR 2.76, 95% CI 1.13 - 6.72, p=0.03) at diagnosis and prior to endoscopic therapy were associated with argon plasma coagulation treatment failure. Nineteen patients of the successful therapy group developed bleeding recurrence; no risk factors were associated with a shorter recurrence-free time. More than four APC sessions were associated to a higher risk of surgical intervention for bleeding control (OR 87.00, 95% CI 10.23 - 740.18, p<0.001).

CONCLUSION: Requirement of red blood cells transfusion and/or hemoglobin <7 g/dl and a severe bleeding frequency (more than 5 days per week) were identified as the most important risk factors for treatment failure in patients with chronic radiation proctopathy.