Endoscopic Infrared Coagulation: Broad Range of Novel and Practical Utility Ranging From Internal Hemorrhoids to NOTES

Elisabeth C McLemore, MD, Sonia Ramamoorthy, MD, Rudy Rai, MD, Junaid Siddiqui, MD, P Patrick Basu, MD, Mousab Tabbaa, MD, Michael S Epstein, MD. University of California, San Diego

Objective: A novel endoscopic delivery system for infrared coagulation therapy has recently been designed and approved by the Food and Drug Administration for use in human subjects. The Precision Endoscopic Infrared CoagulatorTM has a broad range of therapeutic applications ranging from the endoscopic treatment of internal hemorrhoids, angiodysplasia, and hemostasis to a wide variety of applications in natural orifice transluminal endosocpic surgery (NOTES).
Infrared coagulation (IRC) is a well established treatment option for symptomatic internal hemorrhoids. Endoscopic infrared coagulation of internal hemorrhoids is an attractive alternative to the standard infrared coagulator as it can be performed at the same time as a colonoscopy or flexible sigmoidoscopy. Patients with symptomatic hemorrhoids are frequently encouraged to undergo endoscopic evaluation prior to treatment of hemorrhoid disease in order to eliminate other sources of bleeding from the colon and rectum. Currently, the non-surgical treatment options of internal hemorrhoid disease cannot be done without the use of an anal retractor, adequate lighting, and specialized instruments. The non-surgical treatment options are then generally performed at a different time and in a separate location than the endoscopic procedure. This leads to inefficiency in time and expense for the endoscopist, ancillary staff, and the patient.

Technique: The endoscopic infrared coagulator utilizes infrared radiation generated by a portable control box which is applied to the tissue through a flexible, fiber optic light guide (Precision Endoscopic Infrared CoagulatorTM, MAX Endoscopy Inc, Macedonia, OH). The light guide is placed through the colonoscope in the same chamber as other endoscopic instruments (biopsy forceps, snare cautery, etc.). The symptomatic internal submucosal hemorrhoidal vessels are treated in an overlapping, zig zag fashion of three to five 2 – 5 second pulse infrared radiation applications.

Methods: A retrospective review was performed from a prospectively collected database utilizing a standardized protocol in all patients documenting history and physical exam findings. A severity scoring system (range 0 – 4) for bleeding, prolapse, pain, itching, burning, and soiling was documented prior to and 6 weeks after endoscopic IRC.

Preliminary Results: Twenty six patients have undergone endoscopic IRC for predominately Grade II (68%) and Grade III (32%) symptomatic internal hemorrhoids. There were 10 female patients. The mean pre-treatment severity of symptoms from internal hemorrhoids score was 2.45 ± 1.7 and the mean 6 week post-treatment score was 0.40 ± 0.6 (p < 0.0001, Table 1). There have been no adverse events reported to date.

Table 1: Average Pre and Post-Treatment Symptom Scores
SymptomPre-Treatment Average ScorePost-Treatment Average Score

Conclusions: The Precision Endoscopic Infrared CoagulatorTM provides the endoscopist with unparalleled visibility and efficiency allowing simultaneous treatment of symptomatic internal hemorrhoids at the time of diagnostic or therapeutic endoscopy. After a single session of endoscopic IRC, patients have experienced a statistically significant improvement in their symptoms related to internal hemorrhoids. Endoscopic IRC has additional therapeutic utility in the endoscopic management of angiodysplasia, inflammation, hemostasis, and a variety of applications in NOTES.

Session: Emerging Technology
Program Number: ET002

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