Efficacy of endoscopic formalin spray therapy for radiation-induced hemorrhagic proctocolitis

Radiation colitis is a common complication of radiotherapy for pelvic malignancies. Radiation colitis might lead to intractable or massive hemorrhaging unresponsive to conventional therapy. We treated 4 patients with hemorrhagic radiation colitis that required multiple blood transfusions and had low hemoglobin levels, by 4-5% formalin solution spraying under endoscopic observation. Two patients had had prostate cancer, one had had cancer of the vagina, and one had had bladder cancer, treated with radiotherapy at a median time 37 months (range, 8-60 months). Bleeding ceased immediately in all 4 patients, and no major complications occurred, except for temporal anal pain in 2 patients. No further bleeding was noted, and no blood transfusions were needed. Endoscopic formalin spraying treatment is a simple, effective, safe, inexpensive, and minimally invasive therapy for radiation-induced hemorrhagic colitis. (author)