title: Prospective Case Series of a Novel Minimally Invasive Bipolar Coagulation System in the Treatment of Grade I and II Internal Hemorrhoids.
abstract: Background Existing nonsurgical procedures for the treatment of grade I and II internal hemorrhoids are often painful, technically demanding, and often necessitate multiple applications. This study prospectively assessed the safety and efficacy of the HET Bipolar System, a novel minimally invasive device, in the treatment of symptomatic grade I and II internal hemorrhoids. Methods Patients with symptomatic grade I or II internal hemorrhoids despite medical management underwent hemorrhoidal ligation with the HET Bipolar System. Endpoints included resolution or improvement of hemorrhoidal bleeding and/or prolapse from baseline, recurrent or refractory symptoms, and pain. Results Twenty patients were treated with the HET Bipolar System. Two were lost to follow-up. Refractory or recurrent bleeding was present in 8 of 18 (44.4%), 4 of 11 (36.4%), and 4 of 8 (50.0%) patients, and prolapse was reported by 1 of 18 (5.6%), 4 of 11 (36.4%), and 1/7 (14.3%) of patients at 1, 3, and 6 months, respectively. Bleeding improved from baseline in 88.2%, 81.8%, and 87.5% of patients, and resolution of baseline prolapse was seen in 11 of 11 (100%), 4 of 7 (57.1%), and 5 of 5 (100%) patients at the same intervals. Thirteen of 18 (72.2%) patients did not require additional treatment for their symptoms. Conclusions The HET Bipolar System is safe and easy to use with short-term effectiveness comparable to that of currently used techniques for the treatment of symptomatic grade I and II internal hemorrhoids. It may be an effective alternative to rubber band ligation in patients with larger internal hemorrhoids and those with hemorrhoids close to the dentate line in which banding may produce debilitating pain.
authors.affiliation: University Hospitals Case Medical Center, Cleveland, OH, USA benjamin.crawshaw@uhhospitals.org.
authors.forename: Benjamin P
authors.initials: BP
authors.lastname: Crawshaw
authors.affiliation: University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Russ
authors.affiliation: University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Bridget O
authors.initials: BO
authors.lastname: Ermlich
authors.affiliation: University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Conor P
authors.initials: CP
authors.lastname: Delaney
authors.affiliation: University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Champagne
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004564:Electrocoagulation / Q000295:instrumentation* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006484:Hemorrhoids / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008026:Ligation / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D010147:Pain Measurement; D061214:Patient Safety; D010865:Pilot Projects; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: colorectal surgery; evidence based medicine/surgery; interventional endoscopy