Evaluating self-administered sucralfate enemas for reducing rectal bleeding in patients with radiation proctitis

Radiation proctitis is relatively common in patients with pelvic organ cancer and manifests primarily as rectal bleeding. Topical sucralfate is thought to minimise radiation-induced rectal bleeding. Compared with argon plasma coagulation (APC) or formalin instillation, sucralfate enemas do not require hospital admission and have minimal adverse effects. This prospective service evaluation investigated the effectiveness of nurse-led patient education followed by self-administration of sucralfate enemas for reducing rectal bleeding in patients with radiation proctitis. Participants (n=42) were recruited via convenience sampling among patients with radiation proctitis seen in the colorectal outpatient clinic of Queen Mary Hospital in Hong Kong. Participants followed a treatment protocol of self-administered sucralfate enemas accompanied by nurse-led education. The primary outcome was a reduction in rectal bleeding. The secondary outcomes were reductions in hospital admissions, use of APC and use of blood transfusions. The authors propose that self-administered sucralfate enemas can effectively control rectal bleeding in patients experiencing radiation proctitis but that this needs to be accompanied by optimal nurse-led patient education. Further research is needed to determine the long-term comparative effectiveness of these interventions.