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Sergey V. Kantsevoy, MD, PhD
Professor of Medicine
University of Maryland School of Medicine
Director of Therapeutic Endoscopy
Mercy Medical Center
Baltimore, Maryland


A 56-year-old man gradually developed shortness of breath and was not able to tolerate regular physical activity. He went to his primary care physician and blood tests revealed severe anemia. Upper endoscopy and colonoscopy did not reveal the source of bleeding, and the patient was referred to Mercy Medical Center for double balloon enteroscopy (DBE) to evaluate the small bowel as a possible site of the GI bleeding.

During an outpatient visit, the patient described having several episodes of severe rectal bleeding with bright red blood in the toilet and on a toilet tissue. Rectal examination revealed grade II internal hemorrhoids (3 columns of enlarged hemorrhoids prolapsing out of the anus and reduced spontaneously) with signs of recent bleeding (attached blood clots). Instead of performing DBE (a 3-hour-long, labor-intensive procedure under general anesthesia), the patient was offered endoscopic treatment of actively bleeding internal hemorrhoids.

The patient agreed, and unsedated treatment of internal hemorrhoids using the HET™ bipolar system was performed (Figure A and B). Total procedure time was 36 seconds (12 seconds to treat hemorrhoidal branch at 3 o’clock position, 14 seconds for hemorrhoidal branch at 7 o’clock position, and 10 seconds for hemorrhoidal branch at 10 o’clock position). The patient experienced only minor rectal discomfort during the procedure and did not report any pain during and after the treatment. He went home post procedure.

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Figure. (A) Grade II internal hemorrhoids in retroflex view. (B) Internal hemorrhoids post treatment with HET™ bipolar system.
White circular coagulation marks are visible at the sites of treatment with HET™ bipolar system.

A repeat clinical visit a month later demonstrated absence of any rectal bleeding, reduction in hemorrhoidal size, and complete elimination of prolapse. Repeat complete blood cell count showed normal hemoglobin and hematocrit. His presenting symptoms of shortness of breath disappeared and he was able to resume normal physical activity.

The patient was followed prospectively for 5 years after the HET™ procedure, and he did not have any recurrence of anemia or hemorrhoidal bleeding. He never required DBE.