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World Journal of Emergency Medicine 2019年第4期10卷 228-231页

作者： Yan-dong Li Jia-he Xu Jian-jiang Lin Wei-fang Zhu Division of Colon&Rectal Surgery the First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China Division of Dermatology the First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China

BACKGROUND: To investigate the effectiveness of topical application of 4% formaldehyde as a minimally invasive treatment of rectal bleeding due to chronic radiation proctitis(CRP) under direct vision of electronic colonoscope.METHODS: The clinical data of 13 CRP patients complicated with ≥ grade Ⅱ bleeding admitted to our hospital between January 2003 and December 2018 were retrospectively analyzed. Under the guidance of electronic colonoscope,4% formaldehyde combined with 5-aminosalicylic acid(5-ASA) suppositories was topically applied. Patients were followed up for two months after treatment,and the therapeutic effectiveness was observed and analyzed.RESULTS: The rectal bleeding due to CRP was markedly reduced after topical application of 4% formaldehyde under colonoscope in all 13 patients. The bleeding stopped after one treatment session in 11 patients and after the second session in 2 patients. 5-ASA was also applied along with the use of 4% formaldehyde. The therapeutic effectiveness was satisfactory during the 1-and 2-month follow-up period.CONCLUSION: Topical application of 4% formaldehyde under the direct vision of colonoscope as a minimally invasive treatment for CRB-induced bleeding is a simple,effective,affordable,and repeatable technique without obvious complications,which deserves further exploration and promotion.

关键词： Radiation proctitis Rectal bleeding Formaldehyde

Efficacy and complications of argon plasma coagulation for hemorrhagic chronic radiation proctitis

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World Journal of Gastroenterology 2019年第13期25卷 1618-1627页

作者： Qing-Hua Zhong Zhan-Zhen Liu Zi-Xu Yuan Teng-Hui Ma Xiao-Yan Huang Huai-Ming Wang Dai-Ci Chen Jian-Ping Wang Lei Wang Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases Sun Yat-sen University Department of Colorectal Surgery the Sixth Affiliated Hospital Sun Yat-sen University Guangdong Institute of Gastroenterology

BACKGROUND Chronic radiation proctitis(CRP) is a complication which occurs in 1%-5% of patients who undergo radiotherapy for pelvic malignancies. Although a wide range of therapeutic modalities are available, there is no literature to date showing any particularly appropriate therapeutic modality for each disease stage. Argon plasma coagulation(APC) is currently recommended as the firstchoice treatment for hemorrhagic CRP, however, its indication based on longterm follow-up is still unclear. On the hypothesis that the long-term efficacy and safety of APC are not fully understood, we reviewed APC treatment for patients with hemorrhagic CRP from a single center.AIM To assess the long-term efficacy and safety of APC for hemorrhagic CRP.METHODS This is a retrospective study of consecutive patients treated with APC for hemorrhagic CRP from January 2013 to October 2017. Demographics, clinical variables, and typical endoscopic features were recorded independently. Success was defined as either cessation of bleeding or only occasional traces of bloody stools with no further treatments for at least 12 mo after the last APC treatment.We performed univariate and multivariate analyses to identify factors associated with success and risk factors for fistulas.RESULTS Forty-five patients with a median follow-up period of 24 mo(range: 12-67 mo)were enrolled. Fifteen(33.3%) patients required blood transfusion before APC.Successful treatment with APC was achieved in 31(68.9%) patients. The mean number of APC sessions was 1.3(1-3). Multivariate analysis showed that APC failure was independently associated with telangiectasias present on more than50% of the surface area [odds ratio(OR) = 6.53, 95% confidence interval(CI): 1.09-39.19, P = 0.04] and ulcerated area greater than 1 cm^2(OR = 8.15, 95%CI: 1.63-40.88, P = 0.01). Six(13.3%) patients had severe complications involving rectal fistulation. The only factor significantly associated with severe complications was ulcerated area greater than 1 cm^2(P = 0.035).CONCLUSION The long-te

关键词： Argon plasma coagulation Chronic radiation proctitis Radiation proctopathy Efficacy Safety

Near obstructing painful anorectal mass and facial rash in a man with monkeypox: A case report

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World Journal of Clinical Cases 2023年第30期11卷 7418-7423页

作者： Kesiena Akpoigbe Jones Yannick Joan Culpepper-Morgan Department of Gastroenterology Columbia University Medical Center Health+Hospitals/Harlem AffiliationNew YorkNY 10037United States Department of Internal Medicine Columbia University Medical Center Health+Hospitals/Harlem AffiliationNew YorkNY 10037United States

BACKGROUND Monkeypox(MPX)is a zoonotic infection that is endemic in Western and Central Africa along the Congo River basin.It has a high case fatality rate especially in younger age groups.It belongs to the virus family orthopoxvirus like smallpox.It is transmitted from wild animals to humans but human to human transmission has been established.It is often a self-limited infection in endemic regions.Recently,attention has been given to MPX with the spread of infection to Europe and the United States of America(USA).There is currently sporadic infection of MPX in the USA especially amongst men who have sex with men(MSM).It is a serious life-threatening infection in human immunodeficiency virus/acquired immunodeficiency syndrome co-infected individuals especially those who are treatment naïve with severe immunosuppression.CASE SUMMARY We report a 38-year old man who presented with rectal pain,and anal,torso,and facial rash.Abdominal computed tomography scan showed a near obstructive rectal mass with peri-anal fistula.MPX was positive.He was started on tecovirimat(TPOXX)and HAART therapy.Additional treatment provided included vaccinia immunoglobulin following his clinical deterioration.CONCLUSION This case highlights a rare presentation of MPX with peri-anal fistula and near obstructive rectal mass,and the significance of MPX as a differential diagnosis in proctitis in MSM in addition to other sexually transmitted infection like gonorrhea and chlamydia.

关键词： proctitis Monkeypox Human Immunodeficiency Virus Men who have sex with Men Tecovirimat Vaccinia Immunoglobulin Case report

Colostomy is a simple and effective procedure for severe chronic radiation proctitis

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World Journal of Gastroenterology 2016年第24期22卷 5598-5608页

作者： Zi-Xu Yuan Teng-Hui Ma Huai-Ming Wang Qing-Hua Zhong Xi-Hu Yu Qi-Yuan Qin Jian-Ping Wang Lei Wang Department of Colorectal Surgery The Sixth Affiliated Hospital of Sun Yat-Sen University Clinical Research Division Fred Hutchinson Cancer Research Center University of Washington

AIM: To assess the efficacy and safety of diverting colostomy in treating severe hemorrhagic chronic radiation proctitis(CRP). METHODS: Patients with severe hemorrhagic CRP who were admitted from 2008 to 2014 were enrolled into this study. All CRP patients were diagnosed by a combination of pelvic radiation history, clinical rectal bleeding, and endoscopic findings. Inclusion criteria were CRP patients with refractory bleeding with moderate to severe anemia with a hemoglobin level < 90 g/L. The study group included patients who were treated by diverting colostomy, while the control group included patients who received conservative treatment. The remission of bleeding was defined as complete cessation or only occasional bleeding that needed no further treatment. The primary outcome was bleeding remission at 6 mo after treatment. Quality of life beforetreatment and at follow-up was evaluated according to EORTC QLQ C30. Severe CRP complications were recorded during follow-up.RESULTS: Forty-seven consecutive patients were enrolled, including 22 in the colostomy group and 27 in the conservative treatment group. When compared to conservative treatment, colostomy obtained a higher rate of bleeding remission(94% vs 12%), especially in control of transfusion-dependent bleeding(100% vs 0%), and offered a better control of refractory perianal pain(100% vs 0%), and a lower score of bleeding(P < 0.001) at 6 mo after treatment. At 1 year after treatment, colostomy achieved better remission of both moderate bleeding(100% vs 21.5%, P = 0.002) and severe bleeding(100% vs 0%, P < 0.001), obtained a lower score of bleeding(0.8 vs 2.0, P < 0.001), and achieved obvious elevated hemoglobin levels(P = 0.003), when compared to the conservative treatment group. The quality of life dramatically improved after colostomy, which included global health, function, and symptoms, but it was not improved in the control group. Pathological evaluation after colostomy found diffused chronic inflammation cells, and massive fibrosis collagen depositio

关键词： Chronic radiation proctitis Rectal bleeding Diverting colostomy Quality of life Serious complication

Formalin irrigation for hemorrhagic chronic radiation proctitis

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World Journal of Gastroenterology 2015年第12期21卷 3593-3598页

作者： Teng-Hui Ma Zi-Xu Yuan Qing-Hua Zhong Huai-Ming Wang Qi-Yuan Qin Xiao-Xia Chen Jian-Ping Wang Lei Wang Department of Colorectal Surgery The Sixth Affiliated Hospital of Sun Yat-Sen University

AIM: To assess the efficacy and safety of a modified topical formalin irrigation method in refractory hemorrhagic chronic radiation proctitis(CRP). METHODS: Patients with CRP who did not respond to previous medical treatments and presented with grade II-III rectal bleeding according to the Common Terminology Criteria for Adverse Events were enrolled. Patients with anorectal strictures, deep ulcerations, and fistulas were excluded. All patients underwent flexible endoscopic evaluation before treatment. Patient demographics and clinical data, including primary tumor, radiotherapy and previous treatment options, were collected. Patients received topical 4% formalin irrigation in a clasp-knife position under spinal epidural anesthesia in the operating room. Remission of rectal bleeding and related complications were recorded. Defecation, remission of bleeding, and other symptoms were investigated at follow-up. Endoscopic findings in patients with rectovaginal fistulas were analyzed.RESULTS: Twenty-four patients(19 female, 5 male) with a mean age of 61.5 ± 9.5 years were enrolled. The mean time from the end of radiotherapy to the onset of bleeding was 11.1 ± 9.0 mo(range: 2-24 mo). Six patients(25.0%) were blood transfusion dependent. The median preoperative Vienna Rectoscopy Score(VRS) was 3 points. Nineteen patients(79.2%) received only one course of topical formalin irrigation, and five(20.8%) required a second course. No side effects were observed. One month after treatment, bleeding cessation was complete in five patients and obvious in14; the effectiveness rate was 79.1%(19/24). For longterm efficacy, 5/16, 1/9 and 0/6 patients complained of persistent bleeding at 1, 2 and 5 years after treatment, respectively. Three rectovaginal fistulas were found at 1 mo, 3 mo and 2 years after treatment. Univariate analysis showed associations of higher endoscopic VRS and ulceration score with risk of developing rectovaginal fistula. CONCLUSION: Modified formalin irrigation is an effective and safe method for hemorrhagic CRP

关键词： Chronic radiation proctitis Efficacy Rectal bleedi

Gastrointestinal radiation injury:Prevention and treatment

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World Journal of Gastroenterology 2013年第2期19卷 199-208页

作者： Abobakr K Shadad Frank J Sullivan Joseph D Martin Laurence J Egan Department of Gastroenterology University Hospital GalwayUniversity Hospital Galway34562 GalwayIreland Department of Pharmacology and Therapeutics School of MedicineUniversity Hospital Galway34562 GalwayIreland Department of Radiation Oncology National University of Ireland GalwayUniversity Hospital Galway34562 GalwayIreland

With the recent advances in detection and treatment of cancer,there is an increasing emphasis on the efficacy and safety aspects of cancer therapy.Radiation therapy is a common treatment for a wide variety of cancers,either alone or in combination with other treatments.Ionising radiation injury to the gastrointestinal tract is a frequent side effect of radiation therapy and a considerable proportion of patients suffer acute or chronic gastrointestinal symptoms as a result.These side effects often cause morbidity and may in some cases lower the efficacy of radiotherapy treatment.Radiation injury to the gastrointestinal tract can be minimised by either of two strategies:technical strategies which aim to physically shift radiation dose away from the normal intestinal tissues,and biological strategies which aim to modulate the normal tissue response to ionising radiation or to increase its resistance to it.Although considerable improvement in the safety of radiotherapy treatment has been achieved through the use of modern optimised planning and delivery techniques,biological techniques may offer additional further promise.Different agents have been used to prevent or minimize the severity of gastrointestinal injury induced by ionising radiation exposure,including biological,chemical and pharmacological agents.In this review we aim to discuss various technical strategies to prevent gastrointestinal injury during cancer radiotherapy,examine the different therapeutic options for acute and chronic gastrointestinal radiation injury and outline some examples of research directions and considerations for prevention at a pre-clinical level.

关键词： Radiation enteritis Radiation proctitis Prevention Treatment Gastrointestinal radiation injury

Orphan patients with inflammatory bowel disease-when we treat beyond evidence

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World Journal of Gastroenterology 2021年第47期27卷 8047-8057页

作者： Giuseppe Privitera Daniela Pugliese Loris Riccardo Lopetuso Franco Scaldaferri Alfredo Papa GianLodovico Rapaccini Antonio Gasbarrini Alessandro Armuzzi Dipartimento Universitario di Medicina e Chirurgia Traslazionale UniversitàCattolica del Sacro CuoreRome 00168Italy CEMAD–IBD UNIT-UnitàOperativa Complessa di Medicina Interna e Gastroenterologia Dipartimento di Scienze Mediche e ChirurgicheFondazione Policlinico Universitario"A.Gemelli"IRCCSRome 00168Italy CEMAD–IBD UNIT-UnitàOperativa Complessa di Medicina Interna e Gastroenterologia Dipartimento di Scienze Mediche e ChirurgicheFondazione Policlinico Universitario“A.Gemelli”IRCCSRome 00168Italy Department of Medicine and Ageing Sciences “G.d’Annunzio”University of Chieti-PescaraChieti 66100Italy Center for Advanced Studies and Technology(CAST) “G.d’Annunzio”University of Chieti-PescaraChieti 66100Italy

Inflammatory bowel disease(IBD)is a chronic condition that requires continuous medical treatment.To date,the medical management of patients with moderatelyto-severely active IBD who develop dependence or resistance to corticosteroids is based on immunomodulator drugs.Such therapies are licenced after passing through three phases of randomized controlled trials(RCTs),and are subsequently adopted in clinical practice.However,the real-life population of IBD patients who require these therapies can significantly differ from those included in RCTs.As a matter of fact,there is a number of exclusion criteria–nearly ubiquitous in all RCTs–that prevent the enrolment of specific patients:Chronic refractory pouchitis or isolated proctitis in ulcerative colitis,short-bowel syndrome and stomas in Crohn’s disease,ileorectal anastomosis in both ulcerative colitis and Crohn’s disease,and elderly age are some representative examples.In this frontier article,we aim to give an overview of current literature on this topic,in order to address the main knowledge gaps that need to be filled in the upcoming years.

关键词： Pouchitis proctitis Stoma Short-bowel Ileo-rectal anastomosis Biologics

Chronic haemorrhagic radiation proctitis: A review

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World Journal of Gastrointestinal Surgery 2016年第7期8卷 483-491页

作者： Vishnu Prasad Nelamangala Ramakrishnaiah Srinivasan Krishnamachari Department of Surgery Jawaharlal Institute of Postgraduate Medical Education and Research

Chronic haemorrhagic radiation proctitis(CHRP) is a difficult problem faced by the patients following radiation for pelvic malignancy. There is no standardtreatment for this condition, but many methods of treatment are available. The aim of this study was to review the literature to see whether there is an improvement in the available evidence in comparison with previously published systematic reviews in treating patients with CHRP. The Pub Med/Medline database and Google Scholar search was selectively searched. Studies, which treated patients with rectal bleeding due to chronic radiation proctitis or CHRP, were included. Seventy studies were finally selected out of which 14 were randomized controlled clinical trials. Though these studies could not be compared, it could be seen that there was an improvement in the methodology of the studies. There was an objective assessment of symptoms, signs and an objective assessment of outcomes. But, still, there were only a few studies that looked into the quality of life following treatment of CHRP. To increase recruitment to trials, a national registry of cases with established late radiation toxicity would facilitate the further improvement of such studies. Some of the conclusions that could be reached based on the available evidence are 4% formalin should be the first line treatment for patients with CHRP. Formalin and argon plasma coagulation(APC) are equally effective, but formalin is better for severe disease. Refractory patients, not responding to formalin or APC, need to be referred for hyperbaric oxygen therapy or surgery. Radio-frequency ablation is a promising modality that needs to be studied further in randomized trials.

关键词： Radiotherapy Complications Systematic review proctitis Formalin

Endoscopic treatments for chronic radiation proctitis

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World Journal of Gastrointestinal Endoscopy 2013年第7期5卷 308-312页

作者： George Karamanolis Panagiota Psatha Konstantinos Triantafyllou Gastroenterology Unit 2nd Department of Surgery "Aretaieio" University Hospital Athens University11528 Athens Greece Hepatogastroenterology Unit 2nd Department of Internal Medicine and Research Institute "Attikon" University General Hospital Athens University12462 Athens Greece

Chronic radiation proctitis is a complication that occurs in patients who receive radiation therapy for pelvic malignancies. The common presentation is with rectal bleeding, but also rectal pain, diarrhea, tenesmus and even passage of mucus can occur. The optimal treatment of bleeding due to radiation proctitis remains unclear. Among various therapeutic options, medical management is generally ineffective and surgical intervention has a high incidence of morbidity. Promising advances have been made in endoscopic therapy, including argon plasma coagulation (APC), formalin application as well as new techniques such as radio-frequency ablation and cryoablation. APC is a safe, highly effective and long-lasting therapy in patients with rectal bleeding associated with radiation proctitis. It has been shown that several sessions of APC reduce the rate of bleeding and therefore the blood transfusion requirements. Moreover, the effect of treatment is long lasting. However, best results are achieved in patients with mild to moderate radiation proctitis, leaving space for alternative treatments for patients with more severe disease. In patients with severe or refractoryradiation proctitis intra rectal formalin application is an appropriate treatment option. Radiofrequency ablation and cryoablation have shown efficacy as alternative methods in a limited number of patients with refractory chronic radiation proctitis.

关键词： Radiation proctitis Endoscopic treatment Argon plasma coagulation Formalin application Cryoablation Radiofrequency ablation

Novel topical therapies for distal colitis

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2010年第5期1卷 87-93页

作者： Ian Craig Lawrance Centre for Inflammatory Bowel Diseases Department of Gastroenterology Fremantle Hospital Fremantle 6059 WA Australia University Department of Medicine and Pharmacology University of Western Australia Fremantle Hos- pital Fremantle 6059 WA Australia

Distal colitis(DC) can be effectively treated with topical 5ASA agents.Suppositories target the rectum while enemas can reliably reach the splenic flexure.Used in combination with oral 5ASAs,the control of the inflammation is even more effective.Unfortunately,resistant DC does occur and can be extremely challenging to manage.In these patients,the use of steroids,immunosuppressants and the anti-tumor necrosis factor α agents are often required.These,however,can be associated with systemic side effects and are not always effective.The investigation of new topical therapeutic agents is thus required as they are rarely associated with significant blood drug levels and side effects are infrequent.Some of the agents that have been proposed for use in resistant distal colitis include butyrate,cyclosporine and nicotine enemas as well as tacrolimus suppositories and tacrolimus,ecabet sodium,arsenic,lidocaine,rebamipide and Ridogrel enemas.Some of these agents have demonstrated impressive results but the majority of the agents have only been assessed in small open-labelled patient cohorts.Further work is thus required with the investigation of promising agents in the context of randomized double-blinded placebo controlled trials.This review aims to highlight those potentially effective therapies in the management of resistant distal colitis and to promote interest in furthering their investigation.

关键词： Resistant proctitis Tacrolimus Treatment Topical