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Aim:
To compare the efficacy, safety and number of sessions of bipolar eletrocoagulation (BEC) and argon plasma coagulation (APC) in the management of the bleeding telangiectasias from chronic radiation coloproctopathy (CRCP).
Methods:
Thirty patients with active bleeding from telangiectasias were enrolled in two groups (15 BEC and 15 APC) and classified according of Saunders score. BEC settings were 50 W and APC settings were 40 W and 1.0 l/min. Colonoscopy was the first exam to rule out synchronous lesions and follow-up was performed with sigmoidoscopies. Clinical cure was defined as cessation of bleeding and endoscopic cure was determined by absence of telangiectasias. Failure was defined whenever more than 7 sessions or other therapy was necessary.
Thirty patients with active and chronic hematochezia from radiation telangiectasias were randomized in two groups :
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| 1 | Active Comparator | Bipolar Eletrocoagulation was performed with a high-frequency electrosurgical generator (ERBEĀ® ICC 200 Eletromedizin, Tubingen, Germany), using Gold probe (Wilson- CookĀ®) with 7 Fr diameter and 300 cm length. The power setting was 50 W. Coagulation of each telangiectasia was achieved with the probes by applying light pressure directly on the telangiectasia. |
|
| 2 | Active Comparator | Argon Plasma Coagulation was delivered using a "spray-painting" technique, with short applications at 40 W power with a gas flow of 1.0l per minute. APC equipment was an argon delivery unit (ERBEĀ® ICC 300) coupled a high frequency surgery unit (ERBEĀ® ICC 200). Only the end-firing probe with 2.3 mm and 220 cm length was used. The probe was purged with argon, tested and passed though the endoscope until it extends approximately 1 cm from the tip. The probe was hold just above the mucosal surface and the contact was avoided. During the procedure periodic suction was made to prevent over-distention with gas and consequently patient discomfort. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Bipolar eletrocoagulation | Device | Bipolar Eletrocoagulation was performed with a high-frequency electrosurgical generator (ERBEĀ® ICC 200 Eletromedizin, Tubingen, Germany), using Gold probe (Wilson- CookĀ®) with 7 Fr diameter and 300 cm length. The power setting was 50 W. Coagulation of each telangiectasia was achieved with the probes by applying light pressure directly on the telangiectasia. |
| Measure | Description | Time Frame |
|---|---|---|
| Improve of rectal bleeding | 6 months |
| Measure | Description | Time Frame |
|---|---|---|
| Complications of each group | 6 months |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Angelo Ferrari, PhD | Federal University of SĆ£o Paulo | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Federal University Of SĆ£o Paulo - Gastroenterology | SĆ£o Paulo | SĆ£o Paulo | Brazil |
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| ID | Term |
|---|---|
| D011832 | Radiation Injuries |
| D013684 | Telangiectasis |
| ID | Term |
|---|---|
| D014947 | Wounds and Injuries |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
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| ID | Term |
|---|---|
| D057908 | Argon Plasma Coagulation |
| D054020 | Lasers, Gas |
| ID | Term |
|---|---|
| D004564 | Electrocoagulation |
| D002425 | Cautery |
| D013812 | Therapeutics |
| D006489 | Hemostatic Techniques |
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|
|
| Argon Plasma Coagulation | Device | Argon plasma coagulation was delivered using a "spray-painting" technique, with short applications at 40 W power with a gas flow of 1.0l per minute. APC equipment was an argon delivery unit (ERBEĀ® ICC 300) coupled a high frequency surgery unit (ERBEĀ® ICC 200). Only the end-firing probe with 2.3 mm and 220 cm length was used. The probe was purged with argon, tested and passed though the endoscope until it extends approximately 1 cm from the tip. The probe was hold just above the mucosal surface and the contact was avoided. During the procedure periodic suction was made to prevent over-distention with gas and consequently patient discomfort. |
|
|
| D055011 |
| Ablation Techniques |
| D013514 | Surgical Procedures, Operative |
| D006488 | Hemostasis, Surgical |
| D007834 | Lasers |
| D055096 | Optical Devices |
| D004864 | Equipment and Supplies |
| D055618 | Radiation Equipment and Supplies |