Question

Endoscopic management of chronic radiation colitis.

Hint:

Endoscopic management of chronic radiation colitis can significantly improve symptoms, but it is important to recognize the limits of endoscopic treatment in advanced cases.

Answer 1

Chronic radiation colitis is a long-term complication of radiation therapy affecting the colon. Endoscopic management aims to alleviate symptoms and improve quality of life, focusing on controlling bleeding and managing strictures or fistulas caused by radiation injury.
Step 1: Symptoms and Diagnosis:
1. Symptoms: Patients may experience rectal bleeding, diarrhea, abdominal pain, and tenesmus (feeling of incomplete bowel evacuation).
2. Diagnosis: Diagnosis is typically made via colonoscopy, which reveals mucosal changes such as telangiectasia, strictures, and ulceration.
Step 2: Endoscopic Treatment Options:
1. Argon Plasma Coagulation (APC): APC is commonly used to treat radiation-induced bleeding by cauterizing blood vessels in the affected area.
2. Steroid Injection: Local injection of steroids can reduce inflammation and improve symptoms.
3. Dilation of Strictures: Endoscopic balloon dilation can be performed to treat strictures that result from radiation injury, improving colonic passage.
Step 3: Limitations and Risks:
1. Limitations: Endoscopic treatments may provide temporary relief, and patients with extensive radiation damage may not benefit as much.
2. Risks: Risks include perforation, bleeding, and failure of the procedure, especially in patients with severe fibrosis.