NEW ENDOLUMINAL DEVICE FOR MINIMALLY INVASIVE TREATMENT OF HEMORRHOIDS

Sergey V. Kantsevoy, MD, PhD, Director of Therapeutic Endoscopy
Institute for Digestive Health and Liver Disease At Mercy Medical Center
Baltimore, Maryland, USA

Brief overview of the anorectal anatomy:
Grading of hemorrhoids

I – No prolapse
II – Hemorrhoids prolapse through anus, but reduce spontaneously
III - Hemorrhoids prolapse through anus and require manual reduction
IV - Hemorrhoids prolapse through anus and cannot be reduced

Conservative treatment of hemorrhoids:

Fiber
Water
Topical steroids
No magazines in bathroom!

In-office non-surgical treatment of hemorrhoids: Common mechanism - fixation of mucosa to underlying rectal wall to prevent engorgement and prolapse

Banding
Sclerotherapy
Infrared coagulation
Sonographic ligation

Surgical treatment

Excision
Open (Milligan-Morgan)
Closed (Ferguson)
Stapled hemorrhoidopexy
PPH procedure

HET bi polar ligator is a new, minimally invasive device for the treatment of symptomatic Grade I and II hemorrhoids:

Modified anoscope.
It is inserted into the anal canal under direct visualization.
The tissue fold above the dentate line, just proximal to and/or including the proximal portion of the internal hemorrhoid is grasped with the HET device.
Then this tissue is treated with bipolar RF energy at 10 Watts until the treated tissue temperature reached 55-60C.
All three columns of hemorrhoids are treated in one procedure.

Results of clinical use of HET bipolar ligator:

The device was easy to use.
All procedures done in out-patient setting.
Time of radio frequency application ranged from 7 to 26 seconds.
The procedures were easily tolerated by all patients.
The device effectively caused cessation of rectal bleeding and elimination of the prolapse.

Conclusion
The newly developed HET bipolar device was easy to use, well-tolerated by the patients, safe and highly effective in patients with Grade I and II hemorrhoids