Thermal Therapy for Angioectasia and Radiation Proctitis

Written by A/Prof Viraj Kariyawasam, Gastroenterologist

1. What is Thermal Therapy?

Thermal therapy is an endoscopic treatment used to control gastrointestinal bleeding by applying controlled heat to abnormal or fragile blood vessels. It is commonly used to treat conditions such as angioectasia (angiodysplasia) and radiation proctitis.

The aim of thermal therapy is to seal bleeding vessels, reduce recurrent bleeding, and improve symptoms such as iron deficiency anaemia.

2. What are Angioectasia and Radiation Proctitis?

Angioectasia are fragile, abnormal blood vessels that develop in the lining of the gastrointestinal tract. They are a common cause of chronic or recurrent gastrointestinal bleeding, particularly in older adults and in people with chronic medical conditions.

Radiation proctitis occurs when the rectum is damaged following pelvic radiotherapy, most commonly for prostate, cervical, or other pelvic cancers. The lining of the rectum becomes inflamed and develops fragile blood vessels that can bleed easily.

3. Symptoms & How These Conditions Present

Both angioectasia and radiation proctitis commonly cause chronic or intermittent bleeding.

Symptoms may include visible rectal bleeding, dark stools, iron deficiency anaemia, fatigue, shortness of breath, or the need for repeated iron infusions or blood transfusions.

4. How is Thermal Therapy Performed?

Thermal therapy is performed during endoscopy or colonoscopy under sedation.

Several techniques may be used, including argon plasma coagulation (APC), bipolar cautery, or other thermal devices. These allow precise treatment of abnormal blood vessels while minimising damage to surrounding tissue.

5. Effectiveness of Thermal Therapy

Thermal therapy is highly effective in controlling bleeding from angioectasia and radiation proctitis.

Many patients experience a significant reduction in bleeding and improvement in iron levels following treatment. Some conditions may require more than one treatment session, particularly if bleeding vessels are widespread.

6. Risks & Safety Considerations

Thermal therapy is generally safe when performed by experienced endoscopists.

Potential risks include pain, ulceration, stricturing, or rarely perforation. The risk depends on the extent of disease, location treated, and underlying tissue fragility.

7. Living With / Managing These Conditions

Thermal therapy treats the bleeding vessels but does not always prevent new lesions from forming.

Ongoing follow-up may include repeat endoscopy, iron supplementation, and management of contributing factors such as anticoagulant use or underlying medical conditions.

8. When to Seek Medical Advice

You should seek medical advice if you experience ongoing or recurrent gastrointestinal bleeding, symptoms of anaemia, or require repeated iron infusions or blood transfusions.

Urgent assessment is required for heavy bleeding, dizziness, fainting, or black or bloody stools.