Novel endoscopic delivery modality of infrared coagulation therapy for internal hemorrhoids

Abstract

BackgroundA novel endoscopic delivery system for infrared coagulation therapy (IRC) has been designed recently. IRC is a well-established treatment for symptomatic internal hemorrhoids. Patients frequently undergo lower endoscopy before hemorrhoid treatment to eliminate other sources of bleeding. Current treatment options are difficult to perform without an anal retractor, adequate lighting, and specialized instruments. Endoscopic IRC is an attractive alternative to standard IRC, because it can be performed during the lower endoscopy.TechniqueEndoscopic IRC utilizes infrared radiation generated by a control box, which is applied to the tissue through a flexible, fiber optic light guide (Precision Endoscopic Infrared Coagulator™). The light guide is placed through the colonoscope or flexible sigmoidoscope in the same chamber as other endoscopic instruments.MethodsA retrospective review was performed using a prospectively collected database. A standardized protocol was utilized in all patients. Patients graded their symptoms before and after therapy by using the visual analog symptom severity scoring system (range, 0–10). These results were analyzed by using the nonparametric Wilcoxon signed-rank test. Exact P values were computed by using the R function wilcox.exact.ResultsA total of 55 patients underwent endoscopic IRC for predominately grade II and grade III symptomatic internal hemorrhoids (71 %). There were 22 (40 %) female patients. Posttherapy results indicated a significant improvement in global symptoms (pretreatment average global score = 2.24 vs. posttreatment average global score = 0.28; P < 0.0001). There have been no adverse events reported to date.ConclusionsEndoscopic IRC provides improved visibility and efficiency, allowing simultaneous treatment of symptomatic internal hemorrhoids at the time of lower endoscopy. Patients experienced significant improvement in their symptoms after a single session of endoscopic IRC. There are a variety of additional endoscopic IRC therapeutic utilities: endoscopic management of angiodysplasia, inflammation, hemostasis, and NOTES applications.

Hemorrhoids and Fistulas: New Solutions to Old Problems

“…41 The technique can also be used safely through an endoscope with significant symptom improvement. 42 The equipment cost is significantly higher than that for RBL systems.…”

Progress in endoscopic treatment of hemorrhoids

“…In addition, McLemore et al . [ 62 ] developed an endoscopic infrared electrocoagulation system for the treatment of internal hemorrhoids. The symptoms of 55 patients were significantly improved, and no adverse events occurred.…”

“…Wei [61] showed safety and efficacy of endoscopic unipolar electrocoagulation in 100 cases of grade II-III internal hemorrhoids, and the recurrence rate at 3 years of followup was only 6%. In addition, McLemore et al [62] developed an endoscopic infrared electrocoagulation system for the treatment of internal hemorrhoids. The symptoms of 55 patients were significantly improved, and no adverse events occurred.…”

The Clinical Efficacy of Infrared Photocoagulation Versus Closed Hemorrhoidectomy in Treatment of Hemorrhoid

“…Most previous studies confirm our findings. As indicated by McLemore et al in a prospective interventional case series, 15 improvement in global symptoms was found in almost all patients treated with IRC without notable postoperative complications and thus this procedure was introduced as an efficient modality for treating hemorrhoid. According to the study by Mishalov et al, 16 all components of quality of life were significantly improved following IRC.…”