Harikalan Rajeswaran
Introduction
Hereditary haemorrhagic telangiectasia (HHT) is a rare autosomal dominant
vascular disorder in which fragile nasal telangiectasias cause recurrent epistaxis,
anaemia, and quality-of-life impairment. Laser photocoagulation, particularly
potassium titanyl phosphate (KTP) laser, is the standard ablative modality but is
limited by high operating temperatures (> 400°C), cost, and laser-specific safety
requirements. Radiofrequency coblation delivers energy at lower temperatures
(60–70°C), offering effective haemostasis with reduced collateral mucosal injury
and improved suitability for day-case management pathways.
Methods
A retrospective case series was conducted at a United Kingdom district general
hospital to evaluate the efficacy, safety, and durability of coblation for HHT-related
epistaxis. Patients were identified from electronic records; primary outcomes
included one-year recurrence (need for further surgical intervention) and
documented complications. A narrative literature review was performed using
PubMed/MEDLINE and Google Scholar (inception–July 2025) to identify studies
reporting outcomes of coblation and laser photocoagulation for HHT-associated
epistaxis.
Results
Five patients underwent coblation; for procedures with at least 12 months’ followup, the one-year recurrence rate was 25% (1/4), with no documented
intraoperative or postoperative complications. Across published series, coblation
demonstrated haemostatic efficacy comparable to KTP laser photocoagulation,
with symptom-free intervals ranging from 12 to 30 months. Coblation was
associated with reduced postoperative nasal obstruction, crusting, and pain, with
no reported septal perforations.
Conclusions
Coblation is a safe, effective, and pragmatic alternative to laser photocoagulation
for HHT-related epistaxis. Its low-temperature mechanism limits thermal injury,
while lower consumable costs and simplified safety protocols facilitate efficient
day-surgery pathways, particularly in resource-constrained settings.
Authors
Harikalan Rajeswaran, Frimley Health NHS Foundation Trust, Wexham, United Kingdom
Jerocin Vishani Loyala, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
Muna Ahmed, Surrey and Sussex Healthcare NHS Trust, Surrey, United Kingdom
Sharaf Sheik-Ali, University Hospitals of Northamptonshire NHS Group, Northamptonshire, United Kingdom
Roland Hettige, Frimley Health NHS Foundation Trust, Wexham, United Kingdom