A novel treatment for radiation proctopathy using monopolar spray coagulation with a polypectomy snare tip

Abstract

Figures

Different beam spreads according to snare-tip exposure. a, c Minimal snare-tip exposure (1–2 mm) with lateral beam spreading. b, d Snare tip under the sheath with forward beam spreading.

Oozing bleeding due to radiation proctopathy.

Final aspect after snare-tip spray coagulation of rectal angioectasia.

Follow-up colonoscopy after 4 weeks of spray coagulation hemostasis.

Full text

Radiation proctopathy (RP) is recognized as injury to the rectum due to pelvic radiotherapy 1 . A variety of endoscopic therapies have been used for the management of bleeding from chronic RP, and argon plasma coagulation (APC) is probably the most widely used technique 2 . Spray coagulation (SC) is a novel, non-contact technique for treating vascular lesions. Like APC, SC uses monopolar diathermy to achieve precise, superficial tissue penetration through the tip of a conventional polypectomy snare 3 . However, SC offers several advantages, such as eliminating the need for argon gas, specialized catheters, and dedicated generators, making it more accessible and easier to perform 1 .

During APC, bowel distension and catheter malfunction can occur. The snare-tip SC technique addresses these challenges by providing comparable thermal effects using only a polypectomy snare and spray-mode coagulation (Effect 1, 40 watts). Preclinical data suggest that SC achieves tissue penetration like APC, ensuring effective hemostasis while maintaining a high level of safety profile 4 .

This technique reduces equipment dependency and procedural costs, making it an attractive option, especially in resource-limited settings. The snare-tip SC technique requires a 2–3 mm distance from the lesion. Two configurations are possible: exposing 1–2 mm of the snare tip, so the beam spreads laterally ( Fig. 1 a, c ), or keeping the snare tip inside the sheath, so the beam spreads forward ( Fig. 1 b, d ) 5 .

Different beam spreads according to snare-tip exposure. a, c Minimal snare-tip exposure (1–2 mm) with lateral beam spreading. b, d Snare tip under the sheath with forward beam spreading.

The next video ( Video 1 ) shows a male patient with rectal bleeding after radiotherapy ( Fig. 2 ) due to prostate cancer and aims to show the snare-tip SC technique for treating RP ( Fig. 3 ). Follow-up colonoscopy after 4 weeks shows healing ulcers with adequate endoscopic and clinical response ( Fig. 4 ). More clinical studies are needed to establish its safety and efficacy.

Treatment for radiation proctopathy using monopolar spray coagulation with a polypectomy snare tip.Video 1

Oozing bleeding due to radiation proctopathy.

Final aspect after snare-tip spray coagulation of rectal angioectasia.

Follow-up colonoscopy after 4 weeks of spray coagulation hemostasis.

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