Techniques in Coloproctology

, Volume 23, Issue 8, pp 707–712 | Cite as

Clinical results of infrared coagulation as a treatment of high-grade anal dysplasia: a systematic review

  • J. Corral
  • D. ParésEmail author
  • F. García-Cuyás
  • B. Revollo
  • S. Videla
  • A. Chamorro
  • M. Piñol
  • B. Clotet
  • G. Sirera



Anal intraepithelial neoplasia (AIN) (or low/high grade squamous intraepithelial neoplasia (L/HSIL)) is the precursor of anal of early invasive anal cancer. Different treatment options for local ablation of localized lesions have been reported. The aim of this study was to analyze the clinical efficacy and safety of infrared coagulation for the treatment of anal dysplasia.


A search of the literature was performed in 2019 using PubMed and Cochrane to identify all eligible trials published reporting data on the treatment of anal dysplasia with infrared coagulation. The percentage of squamous cell carcinoma of the the anus that developed in the follow-up and results on major complications after treatment were the primary outcomes.


Twenty-four articles were identified from which 6 were selected with a total of 360 patients included, with a median age of 41.8 years. Three studies were prospective and 3 retrospective, only one was a randomized trial. All articles included males, 4 articles included HIV-positive women and only one article included non HIV infected males. No patient developed major complications after infrared coagulation therapy. Pain was the most common symptom found after the procedure in the different series and mild bleeding that did not require transfusion was the most common complication occurring in 4 to 78% of patients. Median follow-up was between 4.7 and 69 months. No patient developed squamous cell carcinoma after infrared treatment. Recurrent HSIL varied from 10 to 38%. Two studies reported results from follow-up of untreated patients showing that between 72 and 93% of them had persistent HSIL at last follow-up and 4.8% developed squamous cell carcinoma.


Infrared coagulation is a safe and effective method for ablation of high-grade anal dysplasia that could help prevent anal cancer. Continued surveillance is recommended due to the risk of recurrence.


Anal dysplasia Infrared coagulation High resolution anoscopy Anal intraepithelial neoplasia 



No funding.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

As this was a systematic review of existing studies ethical approval was not required.

Informed consent

For this type of study formal consent is not required.


  1. 1.
    Darragh TM, Colgan TJ, Cox JT, Members of LAST Project Work Groups et al (2012) The Lower Anogenital Squamous Terminology Standardization Project for HPV-Associated Lesions: background and consensus recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology. J Low Genit Tract Dis 16:205–242CrossRefGoogle Scholar
  2. 2.
    Welton ML, Sharkey FE, Kahlenberg MS (2004) The etiology and epidemiology of anal cancer. Surg Oncol Clin N Am 13(2):263–275CrossRefGoogle Scholar
  3. 3.
    Berry JM, Jay N, Cranston RD, Darragh TM, Holly EA, Welton ML et al (2014) Progression of anal high-grade squamous intraepithelial lesions to invasive anal cancer among HIV-infected men who have sex with men. Int J Cancer 134(5):1147–1155CrossRefGoogle Scholar
  4. 4.
    Piketty C, Darragh TM, Da Costa M, Bruneval P, Heard I, Kazatchkine MD et al (2003) High prevalence of anal human papillomavirus infection and anal cancer precursors among HIV-infected persons in the absence of anal intercourse. Ann Intern Med [Internet]. American College of Physicians 138(6):453.
  5. 5.
    Pineda CE, Berry JM, Jay N, Palefsky JM, Welton ML (2008) High-resolution anoscopy targeted surgical destruction of anal high-grade squamous intraepithelial lesions: a ten-year experience. Dis Colon Rectum [Internet] 51(6):829–835 (discussion 835–7). Cited 1 Mar 2018
  6. 6.
    Scholefield JH, Ogunbiyi OA, Smith JH, Rogers K, Sharp F (1994) Treatment of anal intraepithelial neoplasia. Br J Surg [Internet] 81(8):1238–1240. Cited 1 Mar 2018
  7. 7.
    Scholefield JH (2004) Treatment of grade III anal intraepithelial neoplasia with photodynamic therapy: report of a case. Dis Colon Rectum 46(11):1555–1559. Tech Coloproctol [Internet] 8(3):200. Cited 1 Mar 2018
  8. 8.
    Hamdan KA, Tait IS, Nadeau V, Padgett M, Carey F, Steele RJ (2003) Treatment of grade III anal intraepithelial neoplasia with photodynamic therapy: report of a case. Dis Colon Rectum [Internet] 46(11):1555–1559. Cited 1 Mar 2018
  9. 9.
    Pehoushek J, Smith KJ (2001) Imiquimod and 5% fluorouracil therapy for anal and perianal squamous cell carcinoma in situ in an HIV-1-positive man. Arch Dermatol [Internet] 137(1):14–16. Cited 1 Mar 2018
  10. 10.
    Lyons M, Francis N, Allen-Mersh TG (1999) Treatment of grade 3 anal intraepithelial neoplasia by complete anal mucosal excision without fecal diversion: report of a case. Dis Colon Rectum [Internet] 42(10):1342–1344. Cited 1 Mar 2018
  11. 11.
    Goldstone SE, Kawalek AZ, Huyett JW (2005) Infrared coagulator: a useful tool for treating anal squamous intraepithelial lesions. Dis Colon Rectum [Internet] 48(5):1042–1054. Cited 1 March 2018
  12. 12.
    Stier EA, Goldstone SE, Berry JM, Panther LA, Jay N, Krown SE et al (2008) Infrared coagulator treatment of high-grade anal dysplasia in HIV-infected individuals: an AIDS Malignancy Consortium pilot study. J Acquir Immune Defic Syndr 47(1):56–61CrossRefGoogle Scholar
  13. 13.
    Cranston RD, Hirschowitz SL, Cortina G, Moe AA (2008) A retrospective clinical study of the treatment of high-grade anal dysplasia by infrared coagulation in a population of HIV-positive men who have sex with men. Int J Std AIDS 19:118–120CrossRefGoogle Scholar
  14. 14.
    Goldstone RN, Goldstone AB, Russ J, Goldstone SE (2011) Long-term follow-up of infrared coagulator ablation of anal high-grade dysplasia in men who have sex with men. Dis Colon Rectum [Internet] 54(10):1284–1292. Cited 1 Mar 2018
  15. 15.
    Weis SE, Vecino I, Pogoda JM, Susa JS (2012) Treatment of high-grade anal intraepithelial neoplasia with infrared coagulation in a primary care population of HIV-infected men and women. Dis Colon Rectum 55(12):1236–1243CrossRefGoogle Scholar
  16. 16.
    Sirera G, Videla S, Piñol M, Coll J, García-Cuyás F, Vela S et al (2013) Long-term effectiveness of infrared coagulation for the treatment of anal intraepithelial neoplasia grades 2 and 3 in HIV-infected men and women. Aids 27(6):951–959CrossRefGoogle Scholar
  17. 17.
    Goldstone SE, Lensing SY, Stier EA, Darragh T, Lee JY, van Zante A et al (2018) A randomized clinical trial of infrared coagulation ablation versus active monitoring of intra-anal high-grade dysplasia in HIV-infected adults: An AIDS Malignancy Consortium trial. Clin Infect Dis [Internet]. Cited 21 Nov 2018
  18. 18.
    Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol [Internet] 62:e1–34. Cited 1 Mar 2018
  19. 19.
    Zorzela L, Loke YK, Ioannidis JP, Golder S, Santaguida P, Altman DG et al (2016) PRISMA harms checklist: improving harms reporting in systematic reviews. BMJ 352:i157CrossRefGoogle Scholar
  20. 20.
    Dekkers OM, Egger M, Altman DG, Vandenbroucke JP (2012) Distinguishing case series from cohort studies. Ann Intern Med [Internet]. American College of Physicians 156(1_Part_1):37. Cited 1 Mar 2018
  21. 21.
    Cranston RD, Baker JR, Liu Y, Wang L, Elishaev E, Ho KS (2014) Topical application of trichloroacetic acid is efficacious for the treatment of internal anal high-grade squamous intraepithelial lesions in HIV-positive men. Sex Transm Dis [Internet] 41(7):420–426. Cited 4 Apr 2018
  22. 22.
    Singh JC, Kuohung V, Palefsky JM, Iglesias D, Henostroza G, Seas C et al (2009) Efficacy of trichloroacetic acid in the treatment of anal intraepithelial neoplasia in HIV-positive and HIV-negative men who have sex with men. J Acquir Immune Defic Syndr [Internet] 52(4):474–479. Cited 4 Apr 2018
  23. 23.
    Marks DK, Goldstone SE (2012) Electrocautery ablation of high-grade anal squamous intraepithelial lesions in HIV-negative and HIV-positive men who have sex with men. J Acquir Immune Defic Syndr [Internet] 59(3):259–265. Cited 4 Apr 2018
  24. 24.
    Alemany L, Saunier M, Alvarado I, Quirós B, Salmeron J, Shin H et al (2015) HPV DNA prevalence and type distribution in anal carcinomas worldwide. Int J Cancer [Internet] 1(1361):98–107. Cited 10 Mar 2018

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • J. Corral
    • 1
    • 2
  • D. Parés
    • 1
    • 2
    • 3
    Email author
  • F. García-Cuyás
    • 1
    • 2
  • B. Revollo
    • 2
    • 4
  • S. Videla
    • 2
    • 5
  • A. Chamorro
    • 2
    • 4
  • M. Piñol
    • 1
    • 2
  • B. Clotet
    • 2
    • 3
    • 6
  • G. Sirera
    • 2
    • 4
  1. 1.Colorectal Surgery Unit, Department of General SurgeryHospital Germans Trias i PujolBarcelonaSpain
  2. 2.Lluita Contra la Sida FoundationHospital Universitari Germans Trias i PujolBarcelonaSpain
  3. 3.School of MedicineUniversitat Autónoma de Barcelona (UAB)BarcelonaSpain
  4. 4.HIV Clinical Unit, Department of MedicineUniversity Hospital Germans Trias i PujolBadalonaSpain
  5. 5.Department of Clinical PharmacologyUniversity Hospital Bellvitge/IDIBELL/Barcelona University, Hospitalet de LlobregatBarcelonaSpain
  6. 6.Retrovirology Laboratory IrsiCaixa FoundationBadalonaSpain

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