Nonsurgical treatment of actively bleeding internal hemorrhoids with a novel endoscopic device (with video).

BACKGROUND: Internal hemorrhoids often present with bleeding, prolapse, and other symptoms. Currently used nonsurgical treatment modalities have limited effectiveness and usually require several treatment sessions.

OBJECTIVE: To evaluate effectiveness and safety of a novel endoscopic device for nonsurgical treatment of internal hemorrhoids.

DESIGN: Retrospective study.

SETTING: Single center.

PATIENTS: This study involved 23 patients with actively bleeding internal hemorrhoids.

INTERVENTION: The HET Bipolar System is a modified anoscope, with a treatment window, light source, and tissue temperature monitor. The device is inserted into the rectum under direct observation. The tissue carrying superior hemorrhoidal branches and the apex of the internal hemorrhoid is positioned inside the treatment window, clamped with incorporated tissue forceps, and treated with bipolar energy to ligate hemorrhoidal feeding vessels.

MAIN OUTCOME MEASUREMENTS: Rate of hemorrhoidal bleeding after the treatment.

RESULTS: The mean age of the patients was 64.3 ± 9.9 years (range 44-79 years). Eleven patients (47.8%) had grade I hemorrhoids and 12 patients (52.2%) had grade II hemorrhoids. In 18 patients (78.3%), treatment with the HET System was performed with the patient under conscious sedation. Five patients (21.7%) were treated without sedation. All patients tolerated treatment without complaints. The average follow-up period was 11.2 ± 4.7 months. No bleeding or prolapse occurred after the procedure in any of the treated patients.

LIMITATIONS: Retrospective study.

CONCLUSION: The newly developed HET System is easy to use, safe, and highly effective in eliminating bleeding in grade I and II internal hemorrhoids and prolapse in grade II internal hemorrhoids.