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

Abstract 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 ulceration and stenosis. Radiofrequency ablation (RFA), already successfully used for esophageal lesions, provides controlled and superficial necrosis, promoting mucosal re-epithelialization. The aim of the study was 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. Hemostasis was achieved after 1–2 sessions in all cases, with complete resolution of rectal bleeding and no strictures or ulcerations. No major complications were observed. Endoscopic radiofrequency therapy has been confirmed as an effective, safe, and minimally invasive treatment for chronic actinic proctitis, capable of ensuring long-lasting bleeding control and excellent mucosal healing.