Innovazioni terapeutiche nella proctite attinica cronica: valutazione della radiofrequenza endoscopica come alternativa alle tecniche tradizionali.

1. Abstract Introduction Chronic actinic proctitis is a late complication of pelvic radiotherapy, caused by ischemic microvascular lesions that lead to chronic rectal bleeding, anemia, and a reduction in quality of life. Traditional therapies, including argon plasma coagulation (APC), although effective, are burdened by ulcerations and stenosis. Materials and Methods Radiofrequency ablation (RFA), already successfully used for esophageal lesions, provides controlled and superficial necrosis, promoting mucosal re-epithelialization. The aim of the study is to evaluate the efficacy and safety of RFA in the treatment of refractory chronic actinic proctitis, comparing it with conventional endoscopic techniques. Selected patients were treated with a Barrx™ through-the-scope catheter, applying an energy of 10 J/cm² (300 W). Endoscopic follow-up, using white light and narrow-band imaging (NBI), monitored re-epithelialization and the onset of complications. Results: Between January 1, 2023, and October 31, 2024, 15 patients with symptomatic CRP refractory to conventional medical therapy were enrolled. All patients underwent endoscopic treatment with RFA and subsequent follow-up until October 31, 2025. Control of rectal bleeding was achieved in thirteen patients (86.6%) after 1 or 2 sessions. In the remaining two cases, a significant reduction in bleeding was observed, although not complete remission. Ten patients received a single session (66.6%), while five patients required a second application after 6-8 weeks (33.3%). The complete remission of bleeding observed in 86.6% of patients and partial remission in the remaining 13.4% confirm the hemostatic efficacy of RFA, in line with the findings of major international trials. The progressive improvement in hemoglobin levels and the elimination of transfusion requirements within the first few months after treatment indicate an early and lasting clinical response. Endoscopically, the complete re-epithelialization of the rectal mucosa, with regression of telangiectasias and normalization of the vascular pattern, documented in all patients at the 24-month follow-up, demonstrates that the healing achieved is not only morphological but also functional. The complete absence of ulcerations, stenosis, or late fibrosis confirms the precision and selectivity of radiofrequency-induced superficial ablation, which allows for the preservation of the structural integrity of the rectal wall. Discussion This study represents one of the most recent experiences of the application of endoscopic radiofrequency (RFA) in the treatment of refractory chronic actinic proctitis (CRP), a complex and highly disabling clinical condition that can arise in patients undergoing pelvic radiotherapy for prostate, rectal, endometrial, or cervical cancer. The results obtained in our series highlight the high efficacy of RFA in controlling rectal bleeding and mucosal regeneration, with an excellent safety profile and significant clinical improvement maintained over time. Conclusions Endoscopic radiofrequency has been confirmed as an effective, safe, and minimally invasive method for chronic actinic proctitis, capable of ensuring long-lasting bleeding control and excellent mucosal healing.