I hope that this month’s “Banding Bulletin” finds you well! In this edition, we’ll talk a bit about the value of anoscopy and the limitations that flexible endoscopy has in the evaluation of anorectal disease, and then not-so-coincidentally make an announcement about some new product offerings from CRH! We’ll also update you on our travel plans as well as some of the ancillary support services which are being offered by CRH.
We can’t imagine anything more fitting on “Tax Day” than to offer webinars dealing with the care of hemorrhoids, fissures and other pains in the backside, so Jessica Diduch will be reaching out to you shortly to announce the times available for these webinars as well as to give instructions on how to sign up for one. Our goal in offering these is to allow interested practices to learn more about the CRH O’Regan System and associated treatment protocols.
This 47 year old female patient presented with complaints of perianal itching, difficulty cleaning after bowel movements, and periodic “hemorrhoid flare-ups” after having to strain on defecation. She had no contributory medical history other than some “bowel irregularity” and periodically noted some blood when wiping after a B.M., had a family history of colon cancer, and had just had a “negative” colonoscopy where she was told that she did not have hemorrhoidal issues. She was taking fiber supplementation as recommended by her GI, and while her bouts of symptoms were not quite as frequent, they did persist and were problematic for the patient.
On presentation to my clinic, she was pleasant and in no distress. Her abdominal exam was completely unremarkable, and a perianal exam revealed minimal excoriations and erythema, with no lesions, fistulae or significant external hemorrhoidal changes. Digital anorectal exam revealed a hypertonic internal sphincter with some residual scarring and minimal tenderness in the posterior midline most easily felt within the “intersphincteric groove”. No other masses or abnormalities were noted on digital exam. Anoscopy revealed significant internal hemorrhoids, the largest being in the Right Anterior area, but all 3 cushions noted to be “Grade II” on examination.
The patient received a series of 3 bandings using the CRH O’Regan System at 2-week intervals, with the RA being banded at the initial visit. In addition to the dietary fiber supplementation, increased water consumption, sitz baths and minimizing her time on the commode, the patient was also started on topical nitrates for a fissure which, while partially healed, seemed to be responsible for at least a portion of her symptoms. The patient did well, and was symptom free at the time of discharge from our clinic.
The moral of the story — the colonoscope is NOT a good tool to evaluate the anus and distal-most rectum! The anoscope is your friend!
We’ve listed a few “tricks” that can be used in order to increase the diagnostic yield of a flexible endoscopic exam in our animated video HERE, but the “gold standard” is still the anoscope. The anoscopic exam is quick, easy, and inexpensive to perform. It can also provide a tremendous amount of useful information.
We’ve been working with the folks at OBP Medical, the manufacturers of the ANOSPEC self-lighted anoscope for some time now as their product has made the task of anoscopy that much easier and effective. OBP scopes allow for excellent visibility, contain a built-in LED light, are inexpensive and disposable -, minimizing the cost, hassle and risks attendant to reprocessing reusable devices.
We’ve been using the 18mm Anospec “slotted” and have been very happy with it, however we’re also very excited about the launch of their new 18mm Anospec “beveled” scopes. With no slot and with a bit more length, the exam is more comfortable, and you can more easily see the internal hemorrhoids without having to look “around” the external disease. These scopes can also be used to examine the entire anal circumference with one placement of the scope – making it my own personal favorite when I’m interested in a purely diagnostic exam.
CRH is now happy to announce that we now have a distribution agreement with OBP, so you’ll be able to do some “one stop shopping”! You can order either scope via fax or off our website.
We’ll be writing more about the specifics of the use of both of the OBP scopes, but in the meantime, please contact ME directly if you need any additional information regarding the products or associated techniques.
March was a busy travel month for us, as we participated in a number of conferences across the country. In May, we will be back at DDW in Chicago, and for the first time, at the SGNA in Nashville. If you or any of the others from your practice, hospital or ASC will be attending either of these meetings, please come by and say “hello”! We are happy to answer any questions you might have as well as to support you and your practices to the best of our ability.
Thanks for having a look at this month’s “Banding Bulletin” — please let me know if we can help with anything, and have a great day.