Colon - Cryotherapy for Radiation Proctitis
Comments: This is a demonstration of endoscopic cryotherapy in a patient with radiation induced proctitis and spontaneous bleeding.
Cryotherapy refers to the application of extreme cold temperatures to induce a therapeutic effect. Cryotherapy can be used to treat mucosal vascular lesions such as radiation induced proctitis and arteriovenous malformations and watermelon stomach. Cryotherapy uses CO2 gas and when released through a catheter results in reduction in temperature by the Joule Thompson effect. Here you can see ice formation as a result of the cryo-spray. The spray technique allows rapid treatment of large areas of bleeding. Cryo-spray therapy results in a depth of injury of only 2-3mm in the GI mucosa. Therefore there is little concern if normal mucosa is affected by the cryospray. Currently a drawback of cryospray therapy is temporary loss of visualization during the spray process due to formation of a mist. Throughout the process intermittent endoscopic suction should be applied in order to evacuate CO2 and reduction in the mist effect. The patient should be monitored for abdominal distention during the procedure. Cyrotherapy will result in necrosis of the treated superficial mucosa which will be followed by regeneration by normal mucosa in 7-10 days.
Here you can see the appearance of the mucosa one week following the treatment with cryospray therapy. There is superficial necrosis with loss of friable and erythematous areas of mucosa. Bleeding is no longer evident. In this patient, the application of cyrospray resulted in complete cessation of bleeding and no further transfusions were required. The patient tolerated the procedure well without complications or pain. Cryo-spray therapy is approved by the FDA for the treatment of mucosal vascular lesions, but is not yet released for marketing. The instrument will be marketed as Polar Wand.
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Anthony Kalloo, M.D. Chief of Gastroenterology Johns Hopkins Medical Center |
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Citation: Kalloo, A. (Mar 09 2006). Colon - Cryotherapy for Radiation Proctitis. The DAVE Project. Retrieved Feb, 10, 2010, from http://daveproject.org/viewfilms.cfm?film_id=378 Times viewed since Feb 2006: 4835 |
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