Post Radiation Colitis,  El Salvador Atlas of Gastrointestinal VideoEndoscopy, a large database of images and video clips with cases reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy
Post-Radiation Colitis. This 77 year old woman underwent radiation therapy for cervical cancer approximately one and a half years ago. She remained well over one year. But over the past five months, she has had increasingly frequent episodes of rectal bleeding, requiring two monthly blood transfusions until she was referred to our clinic for specific treatment.

Video Endoscopic Sequence 1 of 13.

Post-Radiation Colitis.

 This 77 year old woman underwent radiation therapy for
 cervical cancer approximately one and a half years ago.
 She remained well over one year. But over the past five
 months, she has had increasingly frequent episodes of
 rectal bleeding requiring
two monthly blood transfusions
 until she was referred to our clinic for specific treatment.

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Post-irradiation proctitis with extensive rectal musocal hypervascularity.  The image and the video clip show evidence of radiation injury. The changes seen here are classic for radiation induced proctitis.

Video Endoscopic Sequence 2 of 13.

 Endoscopic view of Post-irradiation proctitis

 Post-irradiation proctitis with extensive rectal musocal
 hypervascularity

 The image and the video clip show evidence of radiation
 injury. The changes seen here are classic for radiation
 induced proctitis.

 

Post-irradiation mucosal vascular changes.  Colonoscopy demonstrates multiple twisted small telangiectasias compatible with her history of radiation exposure. The most common symptom is rectal bleeding in association with rectal inflammation known as radiation proctitis. The bleeding is caused by new blood vessel formation as a result of the inflammation caused by radiation. These blood vessels are fragile and bleed easily.

Video Endoscopic Sequence 3 of 13.

 (Post-irradiation mucosal vascular changes).

 Colonoscopy demonstrates multiple twisted small
 telangiectasias compatible with her history of
 radiation exposure
.
 The most common symptom is rectal bleeding in association
 with rectal inflammation known as radiation proctitis. The
 bleeding is caused by new blood vessel formation as a
 result of the inflammation caused by radiation. These blood
 vessels are fragile and bleed easily.

Therapy with argon plasma coagulator.

Video Endoscopic Sequence 4 of 13.

 Therapy with argon plasma coagulator.

Non-contact method of coagulation using the APC probe. APC is a non-contact thermal device. A high voltage spark is delivered at the tip of the probe, which ionizes the argon gas as it is sprayed from the probe tip in the direction of the target tissue. Argon gas is non-flammable and inexpensive to refill. It is easily ionized by the 6000 volt peak energy delivered by the tungsten wire that terminates just proximal to the probe tip. This ionized gas or plasma then seeks a ground in the nearest tissue, delivering the thermal energy with a depth of penetration of roughly 2 to 3 mm. The plasma coagulates both linearly and tangentially. By delivering energy to all tissue near the probe tip which will conduct electricity, APC can be used to treat a lesion around a fold and not clearly in view or en face.

Video Endoscopic Sequence 5 of 13.

Non-contact method of coagulation using the APC probe. APC is a non-contact thermal device.

 A high voltage spark is delivered at the tip of the probe,
 which ionizes the argon gas as it is sprayed from the probe
 tip in the direction of the target tissue. Argon gas is
 non-flammable and inexpensive to refill. It is easily ionized
 by the 6000 volt peak energy delivered by the tungsten
 wire that terminates just proximal to the probe tip. This
 ionized gas or plasma then seeks a ground in the nearest
 tissue, delivering the thermal energy with a depth of
 penetration of roughly 2 to 3 mm. The plasma coagulates
 both linearly and tangentially. By delivering energy to all
 tissue near the probe tip which will conduct electricity,
 APC can be used to treat a lesion around a fold and not
 clearly in view or en face
.

Argon Plasma Coagulation is an Effective Treatment for Refractory Hemorrhagic Radiation Proctitis.

Video Endoscopic Sequence 6 of 13.

 Argon Plasma Coagulation is an Effective Treatment for
 Refractory Hemorrhagic Radiation Proctitis.

 



                  
Dis Colon Rectum. 2001 Dec;44(12):1759-1765.

 

One of the most effective treatments for radiation proctitis  is Argon Plasma Coagulation.

Video Endoscopic Sequence 7 of 13.

One of the most effective treatments for radiation proctitis is Argon Plasma Coagulation.

A  forward firing probe is used to fulgurate individual sites. Firstly, argon gas is emitted from the end of the probe running through the endoscope channel. Next, high-frequency current is discharged from an electrosurgery unit. When argon gas becomes electrically conductive ( argon plasma ) this allows the current to reach the targeted mucosa of the tissue which is coagulated shallowly and uniformly. The device is especially effective for the coagulation of hemorrhages on the surface of the tissue.

Video Endoscopic Sequence 8 of 13.

A forward firing probe is used to fulgurate individual sites.

 Firstly, argon gas is emitted from the end of the probe
 running through the endoscope channel. Next,
 high-frequency current is discharged from an
 electrosurgery unit. When argon gas becomes electrically
 conductive ( argon plasma ) this allows the current to reach
 the targeted mucosa of the tissue which is coagulated
 shallowly and uniformly.
 The device is especially effective for the coagulation of
 hemorrhages on the surface of the tissue.

This image as well as the video clips display multiple post treatment ulcers. The goal of endoscopic therapy is to ablate the angioectasias with a resultant improvement in the severity and frequency of rectal bleeding. This will lead to an increase in the hemoglobin level, reduction in transfusion requirements and hopefully, an improvement in quality of life. Candidates for endoscopic therapy include, but are not limited to, patients with chronic hematochezia associated with transfusion dependency.

Video Endoscopic Sequence 9 of 13.

This image as well as the video clips display multiple post treatment ulcers.

 The goal of endoscopic therapy is to ablate the
 angioectasias with a resultant improvement in the severity
 and frequency of rectal bleeding. This will lead to an
 increase in the hemoglobin level, reduction in transfusion
 requirements and hopefully, an improvement in quality of
 life. Candidates for endoscopic therapy include, but are not
 limited to, patients with chronic hematochezia associated
 with transfusion dependency.

The procedures described above are considered to be safe. However, temporary discomfort or pain may occur following introduction of air into the stomach or bowel. Major complications are rare but can occur. These complications include perforation.

Video Endoscopic Sequence 10 of 13.

 The procedures described above are considered to be safe.
 However, temporary discomfort or pain may occur
 following introduction of air into the stomach or bowel.
 Major complications are rare but can occur. These
 complications include perforation.

 

Therapy with argon plasma coagulator. It conducts monopolar electrosurgical current to tissue via an ionized argon gas stream (argon plasma) that is delivered from a small tube that emanates from the colonoscope. The argon gas is ignited and charged and cause a superficial destruction of these abnormal blood vessels and stops the radiation related bleeding. The APC procedure is performed on an outpatient basis and requires only light or no sedation. APC is consider not only effective, but very safe.

Video Endoscopic Sequence 11 of 13.

herapy with argon plasma coagulator.

 It conducts monopolar electrosurgical current to tissue via
 an ionized argon gas stream (argon plasma) that is
 delivered from a small tube that emanates from the
 colonoscope. The argon gas is ignited and charged and
 cause a superficial destruction of these abnormal blood
 vessels and stops the radiation related bleeding. The APC
 procedure is performed on an outpatient basis and requires
 only light or no sedation. APC is consider not only
 effective, but very safe.

At eight weeks, her bleeding is reduced by 95%. Scattered lesions remain as well as healing ulcers at the site of prior application. Remaining vessels are cauterized. APC sessions can be repeated as needed to control bleeding Nine weeks later, the ulcers have healed and only a few Lesions remain. His bleeding has almost completely ceased. She does not need to be seen in follow up unless bleeding recurs.

Video Endoscopic Sequence 12 of 13.

APC sessions can be repeated as needed to control
 bleeding.

 Nine weeks later, the ulcers have healed and only a few
 Lesions remain. Her bleeding has almost completely
 ceased. She does not need to be seen in follow up unless
 bleeding recurs.

Six months later, the nearly complete resolution of the process is observed.

Video Endoscopic Sequence 13 of 13.

Six months later, the nearly complete resolution of the process is observed.

An 80 year-old woman with post-radiation proctitis. The patient has cervix carcinoma and underwent radiotherapy. The images and videos display telangiectasias, which is the physiopathologic cause of this clinical entity. (Post-irradiation mucosal vascular changes). In 1897, 2 years after the discovery of x-rays by Roentgen, radiation-induced intestinal injury was first reported.

Video Endoscopic Sequence 1 of 4.

 Post-Radiation Colitis.

 An 80 year-old woman with post-radiation proctitis.
 The patient has cervix carcinoma and underwent
 radiotherapy. The images and videos display
 telangiectasias, which is the physiopathologic cause of this
 clinical entity.

 In 1897, 2 years after the discovery of x-rays by Roentgen,
 radiation-induced intestinal injury was first reported.

 

Hemorrhagic radiation proctitis.               The proctitis has affected only 3 centimeters above the pectinea line. Radiation injury is the damage to the soft tissue and bone, following radiation therapy.  There are early and late effects (that occur  weeks and  years after the radiation)  caused by ischemia, interruption of the blood supply and direct cells damage, which are sensitive to radiation.

Video Endoscopic Sequence 2 of 4.

 Hemorrhagic radiation proctitis. Retroflexed image.

 The proctitis has affected only 3 centimeters above the
 pectinea line.
 Radiation injury is the damage to the soft tissue and bone,
 following radiation therapy.
 There are early and late effects (that occur weeks and
 years after the radiation) caused by ischemia, interruption
 of the blood supply and direct cells damage, which are
 sensitive to radiation.

                                          Medline.

Therapy with argon plasma coagulator (APC).  Argon Plasma Coagulation, or APC for short, is a new method of electrocoagulation. As a result, it allows for the non-contact application of electrical energy to achieve tissue destruction or hemostasis (the ability to stop bleeding). APC uses high frequency electrical current delivered via ionized argon gas.  This gas, being ionized, allows for the conduction of electricity, thus leading to the term argon plasma.

Video Endoscopic Sequence 3 of 4.

 Therapy with argon plasma coagulator (APC).
 Argon Plasma Coagulation, or APC for short, is a new
 method of electrocoagulation. As a result, it allows for the
 non-contact application of electrical energy to achieve
 tissue destruction or hemostasis (the ability to stop
 bleeding). APC uses high frequency electrical current
 delivered via ionized argon gas. This gas, being
 ionized, allows for the conduction of electricity, thus
 leading to the term "argon plasma".        
Medline:

Status post the argon treatment, image in retroflexion. Radiation has been used in the treatment of cancers since the 1930's. It still remains the mainstay of treatment for cervical and vaginal carcinomas around the world. Its role in the treatment of other gynaecological cancers is less assured. It will probably continue to play a role in the management of some endometrial and vulvar carcinomas. Radiotherapy may be the only treatment or part of a multidisciplinary treatment plan, this reflects the modern approach to the management of gynaecological cancers.

Video Endoscopic Sequence 4 of 4.

 Status post the argon treatment, image in retrofletion.
 Radiation has been used in the treatment of cancers since
 the 1930's. It still remains the mainstay of treatment for
 cervical and vaginal carcinomas around the world. Its role
 in the treatment of other gynaecological cancers is less
 assured. It will probably continue to play a role in the
 management of some endometrial and vulvar carcinomas.
 Radiotherapy may be the only treatment or part of a
 multidisciplinary treatment plan, this reflects the
modern
 approach to the management of gynaecological
 cancers.
  
   

Radiation Proctosigmoiditis. Post-irradiation proctopathy in a 71 year-old man, who underwent radiation therapy for prostatic carcinoma. The image and the video display hemorrhage, clots and telangiectasias.

Video Endoscopic Sequence 1 of 14.

Radiation Proctosigmoiditis.

 Post-irradiation proctopathy in a 71 year-old man, who
 underwent radiation therapy for prostatic carcinoma.
 The image and the video display hemorrhage, clots and
 telangiectasias
.


                                        

Radiation Proctosigmoiditis. The typical endoscopic appearance is characterized by telangiectasias and hemorrhagic mucosal changes. The symptoms may arise months to years after the end of radiotherapy and mainly include tenesmus with discharge of mucus and blood.

Video Endoscopic Sequence 2 of 14.

Radiation Proctosigmoiditis.

 The typical endoscopic appearance is characterized by
 telangiectasias and hemorrhagic mucosal changes.
 The symptoms may arise months to years after the end of
 radiotherapy and mainly include tenesmus with discharge
 of mucus and blood.

 

Radiation Proctitis. Post-irradiation proctopathy in a 71 year-old man, who had underwent radiation therapy for prostatic carcinoma. The image and the video display hemorrhage, clots and telangiectasias.

Video Endoscopic Sequence 3 of 14.

Radiation Proctitis.

 Post-irradiation proctopathy in a 71 year-old man, who
 had underwent radiation therapy for prostatic carcinoma.

 The image and the video display hemorrhage, clots and
 
telangiectasias
.

Argon Plasma Coagulation beam, in a case of post radiation proctitis, due to prostatic carcinoma 3 years  before.     The patient underwent radiotherapy. Six months later that patient started with rectal discharge.

            Video Endoscopic Sequence 4 of 14.
 
 Argon Plasma Coagulation beam, in a case of post
 radiation proctitis, due to prostatic carcinoma 3 years
 
before.

 The patient underwent radiotherapy. Six
 months later that patient started with rectal discharge. 
 
 

Argon Plasma Coagulation treatment, in a case of post radiation proctitis, due to prostatic carcinoma. Radiation proctosigmoiditis is a frequent complication of radiation therapy, used in the treatment of cervix or uterus cancer in  women, prostate and testes cancer in men and urine bladder in both sexes. Eradication of hypervascularity using an argon plasma coagulator. A single pulse has been delivered, with a visiblecoagulation effect.

Video Endoscopic Sequence 5 of 14.

 Argon Plasma Coagulation treatment, in a case of post
 radiation proctitis, due to prostatic carcinoma.
 Radiation proctosigmoiditis is a frequent complication of
 radiation therapy, used in the treatment of cervix or
 uterus cancer in women, prostate and testes cancer in
 men and urine bladder in both sexes.
 Eradication of hypervascularity using an argon plasma
 coagulator. A single pulse has been delivered, with a
 visiblecoagulation effect.

 

Radiation is a common therapy administered to patients with malignant disease in the pelvis, within or outside the abdomen. It  may be administered alone or in conjunction with various types of chemotherapy, some of which increase the risk of radiation injury to the gastrointestinal tract.

Video Endoscopic Sequence 6 of 14.

 Radiation is a common therapy administered to patients
 with malignant disease in the pelvis
, within or outside the
 abdomen.
It may be administered alone or in
 conjunction with various types of chemotherapy, some of
 which increase the risk of radiation injury to
 the gastrointestinal tract.


 

As many as half of the patients with various cancers receive some form of radiation. One to three weeks later, almost 50 to 75 percent experienced a subacute gastrointestinal syndrome. An estimated 0.5 to 17 percent (average: 5 percent) go on to develop chronic radiation enterocolitis from nine months later up to 20 years after radiation therapy.

Video Endoscopic Sequence 7 of 14.

 As many as half of the patients with various cancers
 receive some form of radiation. One to three weeks later,
 almost 50 to 75 percent experienced a subacute
 gastrointestinal syndrome. An estimated 0.5 to 17 percent
 (average: 5 percent) go on to develop chronic radiation
 enterocolitis from nine months later up to 20 years after
 radiation therapy.
 

A forward viewing probe is fired in a non contact fashion to spot weld the lesions. The effectiveness of argon plasma therapy of this condition is demonstrated.

Video Endoscopic Sequence 8 of 14.

 demonstrated. 

 

The image and the video display the argon plasma coagulator beam inside of the rectal tissue. The efficacy and safety of argon plasma coagulation therapy in the post radiation colitis is becoming as the best therapy available for radiotherapy´s  secondary effects.

Video Endoscopic Sequence 9 of 14.

 The image and the video display the argon plasma
 coagulator beam inside of the rectal tissue.
 The efficacy and safety of argon plasma coagulation
 therapy in the post radiation colitis is
becoming as the best
 therapy available for radiotherapy´s “secondary effects”. 

 

 Multiple applications of argon beam are observed.

Video Endoscopic Sequence 10 of 14.

 Multiple applications of argon beam are observed.

Sequelae of Radiotherapy. The incidence of severe complications rises with the total dose. The higher the dose the better the local control of the disease; however the complication rate is also higher. Bowel damage ranges from diarrhea and rectal irritation to perforation, obstruction and severe rectal ulceration. Bladder damage may result in a vesico-vaginal fistula.

Video Endoscopic Sequence 11 of 14.

Sequelae of Radiotherapy.

 The incidence of severe complications rises with the total
 dose. The higher the dose the better the local control of the
 disease; however the complication rate is also higher. Bowel
 damage ranges from diarrhea and rectal irritation to
 perforation, obstruction and severe rectal ulceration.
 Bladder damage may result in a vesico-vaginal fistula.
 
 

Various factors are associated with a high risk of late radiation complications: advanced age, hypertension, anaemia, poor nutrition status, diabetes mellitus, obesity, previous abdominal or pelvic surgery, pelvic inflammatory disease, colitis and diverticulitis. If any of these factors are present, the total dose may need to be reduced to minimize the likelihood of complications.

Video Endoscopic Sequence 12 of 14.

 Various factors are associated with a high risk of late
 radiation complications: advanced age, hypertension,
 anaemia, poor nutrition status, diabetes mellitus, obesity,
 previous abdominal or pelvic surgery, pelvic inflammatory
 disease, colitis and diverticulitis. If any of these factors are
 present, the total dose may need to be reduced to
minimize
 the likelihood of complications.

  

The effectiveness of argon coagulator for radiation  proctitis has been established in many clinical trials.

Video Endoscopic Sequence 13 of 14.

 The effectiveness of argon coagulator for radiation
 proctitis has been established in many clinical trials.

Lesions are observed during water lavage. Radiation-induced injury is best described in 2 ways. Acute injury is a function of fractionation of the dose, field size, type of radiation, and frequency of treatment. Acute injury is caused by injury to the mitotically active intestinal crypt cells. On the other hand, chronic radiation injury is  caused by injury to the less mitotically active vascular endothelial and connective tissue cells. Chronic injury is a function of the total dose of radiation used. This accounts for the described biphasic radiation injury.

Video Endoscopic Sequence 14 of 14.

 Lesions are observed during water lavage.

 Radiation-induced injury is best described in 2 ways.
 Acute injury is a function of fractionation of the dose, field
 size, type of radiation, and frequency of treatment. Acute
 injury is caused by injury to the mitotically active intestinal
 crypt cells. On the other hand, chronic radiation injury is
 caused by injury to the less mitotically active vascular
 endothelial and connective tissue cells. Chronic injury is a
 function of the total dose of radiation used. This accounts
 for the described biphasic radiation injury.

Postradiationyz1

Video Endoscopic Sequence 1 of 4.

Radiation Enteritis

This 74 year-old, female, underwent radiation therapy for uterine cervix cancer 6 month after iniciates with rectal bleeding, requiring red blood cell transfusion, a colonoscopy was performed finding the image here presented.

 

In the sigmoid there are some rest of blood that seem to be melena, radiation enteritis was detected in the jejuno the first lesion was found at 150 cm from the Triez angle and the second 200 cm. In spite of argon plasma coagulation therapy, patient continues with bleeding with melena, and multiple transfusions of blood was performed, the upper endoscopy was negative and a angiotac was done finding two areas of bleeding in the jejuno, patient underwent surgery of the jejuno,  reseting 30 cm of jejuno with post irradiation enteritis, (unusual case of radiation enteritis).

Video Endoscopic Sequence 2 of 4.

 In the sigmoid there are some rest of blood that seem to be
 melena, radiation enteritis was detected in the jejuno the
 first lesion was found at 150 cm from the Triez angle and
 the second 200 cm. I
n spite of argon plasma coagulation
 therapy, patient continues with bleeding with melena, and
 multiple
transfusions of blood was performed, the upper
 endoscopy was negative and a angiotac was done finding
 two
areas of bleeding in the jejuno, patient underwent
 surgery of the jejuno, a 30 cm bowel resection was
 performed due to the severe ischemic damage of jejuno
 with post irradiation enteritis, (unusual case of radiation
 enteritis).

 

 Multiple applications of argon beam are observed. Radiation therapy is a powerful method for the control of cancer. The utilization of abdominal or pelvic radiation has been extended, and the incidence of radiation enteritis appears to be increasing. The majority of the induced lesions is in the distal ileum, sigmoid colon, or rectum.

Video Endoscopic Sequence 3 of 4.

 Multiple applications of argon beam are observed.

Radiation therapy is a powerful method for the control of cancer. The utilization of abdominal or pelvic radiation has been extended, and the incidence of radiation enteritis appears to be increasing. The majority of the induced lesions is in the distal ileum, sigmoid colon, or rectum.

 Status post the argon plasma therapy.

Video Endoscopic Sequence 4 of 4.

 Status post the argon plasma therapy