Efficacy and Safety of Radiofrequency Ablation for Treatment of Chronic Radiation Proctitis: A Systematic Review and Meta-Analysis.

McCarty, Thomas R; Garg, Rajat; Rustagi, Tarun

BACKGROUND Although argon plasma coagulation (APC) is the current standard endoscopic treatment for chronic radiation proctitis (CRP), radiofrequency ablation (RFA) has emerged as an attractive alternative. AIM To evaluate the efficacy and safety of RFA for the treatment of CRP. METHODS Searches of PubMed, EMBASE, Web of Science, and Cochrane Library databases were performed from 2004 through March 2018. Review and data abstraction were performed independently by two authors. Measured outcomes included hemoglobin, transfusion dependence, number of treatment sessions, RFA settings, and serious adverse events. RESULTS Six studies (n=71; mean age 73.41±1.88 years; 90.14% males) were included. Thirty-eight percent of patients failed prior treatment with APC. Patients underwent a mean of 1.71±0.34 RFA sessions with 24.54±16.47 RFA applications per session. Pooled clinical and endoscopic success of RFA was 99% (95% CI: 90-100;p<0.001) and 100% (95% CI: 94-100;p<0.001), respectively. Serious adverse events were reported in one patient - pooled rate of 0% (95% CI: 0-3;p<0.001). Mean pre-procedure hemoglobin was 10.38±1.82 gm/dL with significant improvement observed post-RFA (weighted mean difference 2.49 gm/dL (95% CI: 2.16-2.82;p<0.001). Among transfusion dependent patients, 85% (95% CI: 68-97;p<0.001) became transfusion free post-RFA. Pooled mean follow-up was 19.73±9.72 months. CONCLUSION Despite limited long-term data on RFA for CRP, available evidence suggests RFA is an effective and safe treatment.