Johns Hopkins University Hospital Baltimore, MD, United States
Danse Bi, MD, Sarah Al Ghamdi, MD, Olaya Brewer Gutierrez, MD Johns Hopkins University Hospital, Baltimore, MD
Introduction: Endoscopic cryotherapy uses extremely cold temperature to cause superficial mucosa necrosis and ulceration and allows for hemostasis. It has been used for the treatment of radiation proctitis, arteriovenous malformation, GAVE and refractory bleeding from rectal malignancy with good response. We present a case of benign refractory rectal bleeding treated with cryotherapy.
Case Description/Methods: A 72 year old female with PMH of sick sinus syndrome, CVA, POTS, and renal disease presented with recurrent rectal bleeding in the past 4 years. The bleeding occurred 2-3 times a week. She previously failed endoscopic management and underwent sigmoidectomy which also failed to resolve the bleeding. She received blood transfusion biweekly and iron infusions weekly. No history of pelvic radiation or rectal trauma. Colonoscopy showed rectal mucosa with edema, friability and erosions. Biopsy of the area was normal. She returned for flexible sigmoidoscopy which found several tiny erosions with active oozing in the distal rectum. Endoscopic cryotherapy was performed using nitrous oxide targeting areas of erosions. She returned every 3 months for repeat treatment for a total of 3 sessions. At 6 months follow up, she had no further rectal bleeding. Her anemia improved but did not resolve. Her blood transfusion requirements decreased to monthly. Evaluation for other contributing causes of anemia are ongoing.
Discussion: Endoscopic cryotherapy has demonstrated to be an overall safe and effective treatment for mucosa GI bleeds. It can be considered a viable option for the treatment of benign refractory rectal bleed.
Danse Bi indicated no relevant financial relationships.
Sarah Al Ghamdi indicated no relevant financial relationships.
Olaya Brewer Gutierrez indicated no relevant financial relationships.
Danse Bi, MD, Sarah Al Ghamdi, MD, Olaya Brewer Gutierrez, MD. P1761 - Cryotherapy for Benign Refractory Rectal Bleeding, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.