The American Society of Colon and Rectal Surgeons (ASCRS) is dedicated to ensuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. The Clinical Practice Guidelines Committee is charged with leading international efforts in defining quality care for conditions related to the colon, rectum, and anus by developing clinical practice guidelines based on the best available evidence. These guidelines are inclusive, not prescriptive, and are intended for the use of all practitioners, healthcare workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines. Their purpose is to provide information on which decisions can be made rather than to dictate a specific form of treatment.
STATEMENT OF THE PROBLEM
Radiation therapy is frequently used in many types of cancer, including anal, cervical, prostate, and rectal. Although radiation has beneficial effects in treating tumors, collateral damage to the GI tract can occur, and although acute toxicity in the form of either proctitis or enteritis may occur, the more concerning symptom is the development of a chronic hemorrhagic radiation proctitis. Chronic hemorrhagic radiation proctitis is a syndrome marked by hematochezia, mucus discharge, tenesmus, and, often, fecal incontinence.1 The incidence of this condition was previously reported to be as high as 30%2; however, with recent advances in radiation techniques, the delivery of a more targeted external beam radiation to tumors will hopefully minimize collateral toxicity. Current estimates are that ~1% to 5% of patients treated with radiation for pelvic malignancy will experience chronic radiation proctitis.1 Because of the nature of the symptoms associated with this condition, colorectal surgeons are frequently called on for management and should be well versed in the various treatment options. This parameter will grade the evidence of the common interventions, which have been described for chronic hemorrhagic radiation proctitis.
PubMed was used to search MEDLINE for all entries from January 1990 to October 26, 2017, with the results limited to human studies. Search terms included radiation proctitis (n = 757 titles), radiation enteritis (n = 492), radiation proctitis AND each of the following terms: antibiotics (n = 10), argon beam (n = 16), aminosalicylate enema (n = 5), Carafate enema (n = 16), endoscopy (n = 130), formalin (n = 90), hyperbaric oxygen (n = 56), short chain fatty acid (n = 15), and steroid enema (n = 13). The Cochrane Database of Systematic Reviews was searched with the term radiation proctitis. These searches yielded 1278 unique titles (PubMed = 1275, Cochrane = 3) that were screened, and 365 references were directly reviewed, ultimately yielding 56 references for inclusion. Prospective, randomized controlled trials and meta-analyses were given preference in developing these guidelines. Directed searches of the embedded references from the primary articles were also performed in certain circumstances. The final source material used was evaluated for the methodologic quality, the evidence base was examined, and a treatment guideline was formulated by the subcommittee for this guideline. The final grade of recommendation was performed using the Grade of Recommendation, Assessment, Development, and Evaluation system3 (Table 1). Members of the ASCRS Clinical Practice Guidelines Committee worked in joint production of these guidelines from inception to final publication. Recommendations formulated by the subcommittee were then reviewed by the entire Clinical Practice Guidelines Committee for edits and recommendations. Final recommendations were approved by the ASCRS Clinical Guidelines Committee and ASCRS Executive Committee.
Paquette, Vogel, Abbas, Feingold, Steele (2018). The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Chronic Radiation Proctitis. Diseases of the colon and rectum, 2018 Oct;61(10):1135-1140. https://www.ncbi.nlm.nih.gov/pubmed/30192320