Endoscopic Laser Coagulation of Radiation‐Induced Mucosal Vascular Lesions in the Upper Gastrointestinal Tract and Proximal Colon

Endoscopic laser coagulation effectively controls bleeding from radiation‐induced rectal vascular lesions. Objective: To assess the outcome of endoscopic treatment of radiation‐induced bleeding due to vascular lesions located proximal to the sigmoid colon. Methods: We identified 15 consecutive patients with such proximal radiation enteropathy treated at our Institution with Nd:YAG laser between 1984 and 1991. Ten patients (66%) had gastric and/or small bowel involvement, and five (33%) had colonic involvement with or without more proximal lesions. Bleeding first appeared at a mean of 21.2 ± 12.5 months after completion of radiotherapy. Mean duration of gastrointestinal bleeding before laser treatment was 7.6 ± 4.6 months. Results: After completion of laser therapy, bleeding ceased in nine (60%) patients, decreased in three (20%), and persisted in three (20%). The mean hemoglobin level increased from 8.4 ± 0.5 g/dl to 10.4 ± 0.6 g/dl after completion of laser treatments (p < 0.02). The mean number of transfusions per patient per year decreased from 10.5 ± 2.8 to 0.9 ± 0.7 (p < 0.01). No treatment‐related complications or deaths occurred. Conclusions: Endoscopic laser coagulation of radiation‐induced mucosal vascular lesions in the upper gastrointestinal tract and proximal colon appears to be safe and, in most cases, effective.