Argon plasma photocoagulation for prevention of chronic ulcers and bleeding in solitary rectal ulcer syndrome: Scoping review and narrative summary

Background: Solitary Rectal Ulcer Syndrome (SRUS), often called the "three-lies illness," involves ulcers or hyperemic mucosa without ulcers. Its complex and not fully understood etiology makes treatment challenging, focusing primarily on the underlying disease mechanisms. Argon Plasma Photocoagulation (APC) offers potential benefits worth considering for SRUS. This thermal coagulation technique effectively stops bleeding and promotes tissue healing. This review evaluates the effectiveness of APC compared to traditional therapies for managing chronic ulcers and bleeding in SRUS. Methods: Following PRISMA guidelines, we conducted a scoping review using specific search syntaxes related to SRUS and Argon Plasma Coagulation. We systematically searched PubMed, Cochrane, Scopus, ClinicalTrials.gov, and Google Scholar for articles up to December 2022. Results: Out of 431 articles screened, 32 studies met the inclusion criteria. Standard treatments for SRUS include behavioral therapy, sucralfate enemas, bulk laxatives, high-fiber supplements, corticosteroid therapy, and rectopexy. Research indicates that conservative therapy may increase ulcer recurrence and delay healing. In contrast, APC showed improved postoperative ulcer healing, better bleeding control, and lower recurrence rates. Importantly, no complications such as intestinal perforation, fistula, or infection were reported following APC treatment. APC consistently outperformed conventional therapies, enhancing SRUS management when used alongside traditional treatments. Conclusion: Argon Plasma Photocoagulation significantly improves postoperative ulcer healing, bleeding control, and recurrence rates in SRUS patients. APC, combined with conventional therapies, is more effective than traditional treatments alone. Further extensive and conclusive studies comparing APC to conventional therapies are necessary to determine the most effective treatment option for SRUS.