Apurva Shah1, Shravan Bohra2, Swapan Desai3. 1. Department of Gastroenterology, Medical Gastroenterology, Apollo Hospitals International Limited, Bhat, Gandhinagar, 382 426, India. apurvashah411@gmail.com. 2. Department of Gastroenterology, Medical Gastroenterology, Apollo Hospitals International Limited, Bhat, Gandhinagar, 382 426, India. 3. Pathology Department, Apollo Hospitals International Limited, Ahmedabad 382 428, India.
Abstract
BACKGROUND AND AIM: Solitary rectal ulcer syndrome (SRUS) is an uncommon benign disorder of defecation. Management of ulcers is usually unsatisfactory with conventional treatment (laxatives, behavioral therapy, biofeedback, topical treatments, and surgery). Studies on the effectiveness of argon plasma coagulation (APC) for SRUS refractory to conventional treatment is lacking. The aim of the study was to examine the effect of APC with conventional therapy in controlling bleeding and healing of refractory SRUS. METHODS: Fourteen patients of refractory SRUS diagnosed on clinical, colonoscopic, and histological findings, refractory to conventional therapy, were offered multiple sessions of APC in addition to conventional treatment. All patients were followed up to determine bleeding control and ulcer healing. RESULTS: Fourteen patients with a mean duration of symptoms of 9.21 ± 6.94 months were included. All the patients were advised to have a high intake of fluids and laxatives and to undergo biofeedback in addition to the APC. Lesions were located anteriorly (66%), circumferentially (25%), and posteriorly (9%). Mean follow-up duration was 7 months (3 to 12 months). APC enabled bleeding control in all the patients (100%), complete healing of ulcer in 71% (10 patients), and reduction in ulcer size to less than 50% of the initial size in the remaining 29% patients. None of the patients had any procedure-related complications like bowel perforation, infections, or fistula formation. CONCLUSIONS: APC with conventional therapy is effective in controlling bleeding and healing in SRUS refractory to conventional treatment.
BACKGROUND AND AIM: Solitary rectal ulcer syndrome (SRUS) is an uncommon benign disorder of defecation. Management of ulcers is usually unsatisfactory with conventional treatment (laxatives, behavioral therapy, biofeedback, topical treatments, and surgery). Studies on the effectiveness of argon plasma coagulation (APC) for SRUS refractory to conventional treatment is lacking. The aim of the study was to examine the effect of APC with conventional therapy in controlling bleeding and healing of refractory SRUS. METHODS: Fourteen patients of refractory SRUS diagnosed on clinical, colonoscopic, and histological findings, refractory to conventional therapy, were offered multiple sessions of APC in addition to conventional treatment. All patients were followed up to determine bleeding control and ulcer healing. RESULTS: Fourteen patients with a mean duration of symptoms of 9.21 ± 6.94 months were included. All the patients were advised to have a high intake of fluids and laxatives and to undergo biofeedback in addition to the APC. Lesions were located anteriorly (66%), circumferentially (25%), and posteriorly (9%). Mean follow-up duration was 7 months (3 to 12 months). APC enabled bleeding control in all the patients (100%), complete healing of ulcer in 71% (10 patients), and reduction in ulcer size to less than 50% of the initial size in the remaining 29% patients. None of the patients had any procedure-related complications like bowel perforation, infections, or fistula formation. CONCLUSIONS:APC with conventional therapy is effective in controlling bleeding and healing in SRUS refractory to conventional treatment.