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Vascular thermocoagulation-perivascular nerve lesions. An ultrastructural report on the choice between monopolar and bipolar electrocoagulation.

High-frequency coagulation is used with advantage for a number of purposes, including the production of haemostasis during surgery. The morphological changes which thermocoagulation produces in or near the wall of an artery remain, however, largely unknown; and systematic research in the subject is long overdue. As might be expected from clinical experience, the local effects of monopolar thermocoagulation are much more severe and far-reaching than those caused by the bipolar method. For these reasons the bipolar coagulation technique is to be preferred wherever possible.

Animals↗

Endoscopic treatment by snare electrocoagulation prior to Nd:YAG laser photocoagulation in 85 voluminous colorectal villous adenomas.

The association of endoscopic resection with Nd:YAG laser photocoagulation was used to treat benign colorectal villous adenomas. Eight-five patients were included: 49 with surgical contraindications, 35 for whom surgical resection appeared to be too hazardous, and 1 who refused surgery. Forty-five tumors had an axial extension between 1 and 3 cm, and 40 tumors had an axial extension of at least 4 cm. Diathermic snare resection was performed to remove large tumoral fragments prior to laser photocoagulation of the residual flat lesions. Treatments were repeated every 15 days until total tumor destruction was achieved. A carcinoma was detected in biopsy specimens obtained during endoscopic treatment of five patients. Two patients were lost to follow-up. Treatment results could be analyzed in 78 patients. Successful treatment was achieved in 67 patients. Tumor destruction was complete in 77 percent of patients who had lesions of at least 4 cm diameter and in 93 percent of patients with smaller lesions. The axial extension of the tumor was the main factor affecting the results of treatment. No major complications occurred. During the average 103-week follow-up period, 21 percent of the patients with total tumor destruction had a recurrence. The risk of recurrence was correlated with the number of initial treatment sessions and previous surgery treatment. It would appear that the treatment with endoscopic resection prior to Nd:YAG laser photocoagulation is a safe and effective method in the destruction of colorectal villous adenomas.

Adenoma↗

Endoscopic bipolar electrocoagulation: development of a new bipolar coagulator for stopping gastrointestinal bleeding.

We have developed an endoscopically deliverable bipolar coagulator with a pair of active bipolar electrodes and tested its efficacy and safety in canine gastric bleeding models. Hemostasis was achieved with a few applications in all "ulcer maker", gastric serosal vessel, mesenteric vessel and endoscopic "hot biopsy" models. Histologically the mean muscular injury was 10.1% in ulcer maker models and 17.1% in hot biopsy models, significantly less than monopolar electrodes. No full thickness injury resulted. Initial clinical trials in 32 patients with upper gastrointestinal bleeding revealed 100% immediate hemostasis; it could stop spurting arterial bleeding. Our bipolar coagulator is a promising addition to the endoscopic hemostatic methods.

Adolescent↗