Radiofrequency ablation: Solution for a long-time therapeutic dilemma of chronic radiation proctitis?

Background and study aims: Chronic radiation proctitis is a prevalent condition following pelvic radiation therapy, occasionally leading to significant blood loss. Although medical treatment and argon plasma coagulation (APC) are well-established options, endoscopic radiofrequency ablation (RFA) is an emerging treatment that has shown promising results in smaller studies. However, further research, particularly on long-term outcomes, is necessary. This study aimed to evaluate the treatment outcome of endoscopic RFA in patients with chronic radiation proctitis, with a particular focus on long-term outcome. Patients and methods: This retrospective study included all patients treated with RFA for radiation-induced chronic proctitis suffering from hematochezia at the Medical University of Innsbruck, Department of Visceral, Transplant and Thoracic Surgery, between 2018 and 2023. Results: Thirteen patients were included in the study, with RFA being the initial treatment in five cases. RFA sessions were performed once in nine patients, twice in three patients, and three times in one patient. After a median follow-up period of 58 months, 69.2% (n= 9) remained still symptom-free and 30.8% (n= 4) reported only mild rectal bleeding after hard stools. Conclusions: These data indicate that RFA is a highly effective and safe treatment option for chronic radiation proctitis, providing excellent long-term results.