Chronic Radiation Proctopathy and Colopathy

Chronic radiation-induced colonic injury occurs in up to 20% of patients following radiotherapy. The rectum and distal sigmoid colon are most susceptible to radiation damage, and chronic radiation proctopathy generally manifests with anorectal pain, diarrhea, rectal bleeding, and/or anemia. Endoscopic findings include loss of mucosal vasculature, patchy erythema, and angioectasia, which correlate with ischemic endarteritis of the submucosal arterioles, submucosal fibrosis, and angioectasia on histopathological examination. Although most patients develop symptomatic chronic radiation proctopathy within 1–2 years after radiation exposure, they can present up to 30 years after treatment. Radiation proctopathy, found incidentally during endoscopy, does not warrant any therapy. Argon plasma coagulation (APC) is the mainstay of endoscopic therapy for chronic radiation proctopathy. Laser therapy and dilute formalin (2–10%) application are associated with higher complications and are not commonly utilized. In this video presentation, endoscopic findings are described in chronic radiation proctopathy and colopathy as well as APC therapy. This article is part of an expert video encyclopedia.