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Surgical Endoscopy

, Volume 26, Issue 11, pp 3082–3087

First Online: 31 May 2012Received: 11 October 2011Accepted: 26 April 2012


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.

KeywordsInfrared coagulation Hemorrhoids Rectal bleeding Colonoscopy Endoscopy Presented at the SAGES 2011 Annual Meeting, March 30–April 2, 2011, San Antonio, TX.

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Autor: Elisabeth C. McLemore - Rudra Rai - Junaid Siddiqui - P. Patrick Basu - Mousab Tabbaa - Michael S. Epstein


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