From the Research
After application of Purastat for radiation proctopathy, patients should typically remain nil by mouth (NPO) for 2 hours, as this allows the Purastat gel to properly adhere to the treated area and form a protective barrier over the damaged rectal tissue. Purastat is a synthetic peptide hydrogel that works by creating a physical barrier over areas of bleeding or inflammation, promoting tissue healing in radiation-damaged rectal mucosa. The fasting period helps prevent displacement of the gel through eating or drinking, which could reduce its effectiveness.
According to the most recent and highest quality study available, 1, Purastat has been shown to be effective in reducing bleeding and improving endoscopic grade in patients with severe refractory radiation proctopathy. However, this study does not provide specific guidance on the duration of NPO after application of Purastat.
In the absence of specific guidance from the most recent study, we can look to other studies for information on the management of radiation proctopathy. A systematic review of endoscopic and medical therapies for chronic radiation proctopathy found that there is low-level evidence for the effectiveness of endoscopic therapy with argon plasma coagulation in reducing short-term symptoms, and moderate-level evidence for the use of sucralfate enemas 2. However, these studies do not provide information on the use of Purastat or the duration of NPO after its application.
Given the lack of specific guidance on the duration of NPO after application of Purastat, the recommendation to remain NPO for 2 hours is based on general principles of wound healing and the need to allow the Purastat gel to adhere to the treated area. Once this initial period has passed, patients can gradually resume their normal diet, starting with clear liquids and progressing to solid foods as tolerated. However, specific fasting instructions may vary based on individual clinical circumstances, the extent of the radiation proctopathy, and physician preference, so patients should always follow the specific post-procedure instructions provided by their healthcare provider.
Some key points to consider when managing patients with radiation proctopathy include:
- The importance of individualized treatment plans, taking into account the severity of symptoms and the extent of radiation damage
- The need for careful monitoring of patients after application of Purastat, to assess for any adverse effects or complications
- The importance of providing patients with clear instructions on post-procedure care, including dietary restrictions and follow-up appointments.
Overall, while there is limited specific guidance on the duration of NPO after application of Purastat for radiation proctopathy, the available evidence suggests that a short period of fasting, typically 2 hours, is recommended to allow the Purastat gel to adhere to the treated area and promote tissue healing.