Clinical Case: Infrared Coagulation
In part 1 (Screening for Anal Cancer: Who, When, and How) of this 2-part case, we presented a 38-year-old man with HIV who was found to have anal intraepithelial neoplasia grade 3 (AIN3). He was referred for infrared coagulation (IRC) of the AIN3 lesions. After being counseled on the risks and potential benefits of the procedure and alternative therapies, the patient elected to undergo IRC.
The area of AIN3 was identified on anoscopy. The edges of the lesion were demarcated with Lugol's iodine (Figure 1a). The lesion was infiltrated with 1% lidocaine with epinephrine. The lesion was then treated with 1.5-second pulses of IRC. The entire lesion, including the edges, was treated. The coagulated surface layer of epithelium was then removed using a dry swab (Figure 1b). The base was sharply debrided until the submucosal vessels were exposed, and these were coagulated with additional pulses of IRC (Figure 1c). The procedure was repeated on the second lesion.
The patient was given acetaminophen/oxycodonefor postprocedure pain and stool softeners to prevent pain and bleeding. He was advised to avoid receptive anal sex for at least 2 weeks. He was also advised to avoid strenuous lifting for 2 weeks.
