Hemorrhoidal Energy Treatment: A Single-Center Retrospective Analysis of a Novel Technique for Treating Internal Hemorrhoids

Abstract

Introduction: Internal hemorrhoids are a common cause of rectal bleeding. Traditional first line therapy for Grade I & II bleeding internal hemorrhoids has been conservative management. Various non-surgical and surgical treatment modalities are available for bleeding hemorrhoids. A novel, non-surgical, bipolar electrotherapy probe, the Hemorrhoid Energy Treatment (HET) System, has shown efficacy in the management of bleeding Grade I & II hemorrhoids. Methods: The study included 42 adults with Grade I or II internal hemorrhoids and rectal bleeding who underwent HET from March 2015 to March 2016. Each patient had at least 3-month post treatment follow up. Our retrospective chart review study was IRB approved. 38 subjects out of 42 responded to a telephonic follow-up questionnaire. The questionnaire inquired about post-HET pain, complete resolution of bleeding, improvement in bleeding, and use of stool softeners post-HET. Descriptive analysis was performed. Results: The cohort included 15 males and 23 females, with a mean age of 50±14.8 years. Patients reported average symptom duration of 10.8±10 months, prior to treatment. 36 patients underwent HET under moderate sedation, 1 under general anesthesia, and 1 without any sedation. In 29 patients (76%), HET was performed during flexible sigmoidoscopy; in 9 patients (24%) HET was performed during colonoscopy. The mean procedure time was 13.7±6.1 minutes. Our “modified” HET technique (use of pediatric biopsy forceps and gastroscope assistance) was utilized in 5 subjects and our “standard” HET technique (use of HET and gastroscope guidance only) was used in 33 subjects. None of the patients reported pain or rectal discomfort during the procedure. 33 patients (87%) reported no pain post procedure (Fig 1). 28 patients (74%) reported complete resolution of rectal bleeding (Fig 2). 10 patients reported continued bleeding with 8/10 patients from this group reporting improvement in bleeding post HET treatment. 2 patients (5%) reported no improvement in bleeding symptoms. 19 patients (50%) were able to discontinue stool softener use (Table 1).Figure 1Figure 2Table 1: Responses to Telephonic QuestionnaireConclusion: HET enabled complete resolution of hemorrhoidal bleeding in the majority (74%) of our patient cohort. In addition, most patients reported post-procedure improvement in bleeding. HET is a well-tolerated, safe and effective outpatient procedure for treating rectal bleeding due to hemorrhoids. Our study represents the largest reported HET experience to date.