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Novel endoscopic delivery modality of infrared coagulation therapy for internal hemorrhoids.

McLemore EC, Rai R, Siddiqui J, Basu PP, Tabbaa M, Epstein MS - Surg Endosc (2012)

Bottom Line: These results were analyzed by using the nonparametric Wilcoxon signed-rank test.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, University of California, San Diego, San Diego, CA, USA. emclemore@ucsd.edu

ABSTRACT

Background: A 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.

Technique: Endoscopic 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.

Methods: A 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.

Results: A 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.

Conclusions: Endoscopic 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.

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Related in: MedlinePlus

Overlapping “W”: semi-lunar spot endoscopic IRC technique. IRC infrared coagulation
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Fig1: Overlapping “W”: semi-lunar spot endoscopic IRC technique. IRC infrared coagulation

Mentions: The endoscope was straightened, and the PRECISION™ Endoscopic Infrared Coagulator single-use flexible fiber optic probe inserted into the endoscope through the biopsy cap. Before insertion, it was gently lubricated on its entire length. The flexible fiber optic probe was inserted using gentle short strokes, taking care not to kink the fiber optic cables upon insertion. The fiber optic probe was advanced until it protruded 1–2 cm from the tip of the scope. The endoscope was then retroflexed in the rectum, and the hemorrhoid columns were identified. Endoscopic infrared coagulation treatment was applied by gently opposing the tip of the probe to the tissue just above the engorged internal hemorrhoid tissue column. The probe was held in place for up to 3–5 S. The probe was then moved to an adjacent location in an overlapping semilunar “W” fashion (Fig. 1). Treatment was performed on one to three internal hemorrhoid quadrants at the discretion of the endoscopist.Fig. 1


Novel endoscopic delivery modality of infrared coagulation therapy for internal hemorrhoids.

McLemore EC, Rai R, Siddiqui J, Basu PP, Tabbaa M, Epstein MS - Surg Endosc (2012)

Overlapping “W”: semi-lunar spot endoscopic IRC technique. IRC infrared coagulation
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3472067&req=5

Fig1: Overlapping “W”: semi-lunar spot endoscopic IRC technique. IRC infrared coagulation
Mentions: The endoscope was straightened, and the PRECISION™ Endoscopic Infrared Coagulator single-use flexible fiber optic probe inserted into the endoscope through the biopsy cap. Before insertion, it was gently lubricated on its entire length. The flexible fiber optic probe was inserted using gentle short strokes, taking care not to kink the fiber optic cables upon insertion. The fiber optic probe was advanced until it protruded 1–2 cm from the tip of the scope. The endoscope was then retroflexed in the rectum, and the hemorrhoid columns were identified. Endoscopic infrared coagulation treatment was applied by gently opposing the tip of the probe to the tissue just above the engorged internal hemorrhoid tissue column. The probe was held in place for up to 3–5 S. The probe was then moved to an adjacent location in an overlapping semilunar “W” fashion (Fig. 1). Treatment was performed on one to three internal hemorrhoid quadrants at the discretion of the endoscopist.Fig. 1

Bottom Line: These results were analyzed by using the nonparametric Wilcoxon signed-rank test.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, University of California, San Diego, San Diego, CA, USA. emclemore@ucsd.edu

ABSTRACT

Background: A 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.

Technique: Endoscopic 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.

Methods: A 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.

Results: A 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.

Conclusions: Endoscopic 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.

Show MeSH
Related in: MedlinePlus