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