Radiofrequency Ablation in the Treatment of Chronic Radiation Enteritis

Radiation enteritis is the most common complication during radiotherapy for malignant tumors in the abdominal cavity, retroperitoneum, and pelvis. Bleeding is one of the common and severe complications in patients with radiation enteritis (Eur J Med Res 30(1):23, 2025). Endoscopic radiofrequency ablation (RFA) has emerged as a potential treatment, but data on its efficacy and safety are limited. This study conducted a retrospective analysis of the clinical data of patients with radiation enteritis whom we treated, aiming to evaluate the efficacy and safety of radiofrequency ablation (RFA) in the treatment of hemorrhagic chronic radiation proctopathy (CRP). In this single-center retrospective study, 18 patients with hemorrhagic CRP who underwent endoscopic RFA were included. Patient demographics, clinical variables, endoscopic features, and treatment outcomes were analyzed. Univariate analysis was performed to identify factors associated with treatment failure, and multivariate analysis was not conducted due to the extremely low number of treatment failure events which would lead to statistically unreliable results and high overfitting risk. The cohort (median age 75 years; 72.2% female) had a median follow-up of 20 months (range: 3–67 months). Hemoglobin levels measured at 6 months post-treatment showed a statistically significant increase compared to pre-treatment levels. Based on the primary endpoint, treatment success was achieved in 15 out of 18 patients (83.3%). Among the 3 patients who did not meet the primary endpoint, 2 required additional endoscopic treatment and 1 continued to experience intermittent hematochezia despite endoscopic improvement. The mean endoscopic score improved from 3.44 to 1.06 (P < 0.001). Given the extremely small number of treatment failure events (n = 2, 11.1%), formal univariate statistical testing for failure-associated factors was not performed; instead, descriptive comparisons were conducted for clinical and endoscopic characteristics of the failed cases. No severe complications (e.g., perforation) occurred; mild to moderate anal pain was the most common adverse event. In this retrospective series, RFA for hemorrhagic CRP was associated with good tolerability, significant improvements in bleeding, hemoglobin levels, and endoscopic appearance, with a good safety profile over medium-term follow-up.