HEAT: HEMORRHOIDAL ERADICATION BY ARGON PLASMA THERAPY USING A NEWLY DESIGNED CAP SYSTEM

Aims:

Hemorrhoid therapy is mainly performed by rubber band ligation. There are recent data indicating the benefit of Argon Plasma Coagulation (APC) in esophageal varices. Hence, we aimed to develop and design a tube system enabling APC therapy of hemorrhoids via a standard colonoscope.

Methods:

A new conical cap for standard colonoscopes was developed and a protoype was produced by 3D printing using polyactic acid (PLA). PLA is a biodegradable thermoplastic aliphatic polyester from renewable resources and already used in medicine e.g. for screws or stents. The conical cap has a locking mechanism to allow either free rotation or locked position of the endoscope. The overtube is inserted together with the colonoscope (Olympus CF190). A funnel-shaped design avoids progression of the tube into the rectum. Through a lateral opening the hemorrhoid prolapses into the overtube. An APC probe is inserted via the working channel. By argon plasma coagulation (forced APC, 80 Watts) the hemorrhoid can be treated under optical control.

Results:

A hemorrhoid therapy using the newly designed HEAT systems was performed successfully in a patient with a history of recurrent hemorrhoid bleedings (Grade III hemorrhoids) and several unsuccessful rubber band ligations performed previously. In total, 4 areas were treated under good visual control. No acute side effects were noted by the patient.

Conclusions:

So far, based on our preliminary experience, a new developed cap system enables a safe APC therapy for hemorrhoids. The conical cap avoids collateral mucosal damage and offers a stable working position in the anal channel. Furthermore, the device can be fixed to a standard colonoscope.