Polidocanol Foam Injected at High Doses with Intravenous Needle: The (Almost) Perfect Treatment of Symptomatic Internal Hemorrhoids

Abstract

Background and Aims: Hemorrhoid disorders are common. This study aimed to assess the efficacy and safety of polidocanol foam injected at high doses with intravenous needle for the treatment of symptomatic internal hemorrhoids that prolapse or bleed. Methods: We evaluated 2,000 consecutive patients with prolapsed hemorrhoids (grades II/III/IV) recruited over 6 years. Foam injection was performed in one to four sessions with polidocanol 2%: 10 mL of the mixture (2 mL liquid plus air) or 20 mL (4 mL liquid plus air). The number of sessions and amount of foam injected depended on initial hemorrhoid size, compliance to receive foam, and clinical response. The mixture, prepared using a three-way tap connected to two 10/20-mL syringes, was injected immediately after preparation using an intravenous needle. The primary endpoint was self-reported satisfaction without major complications at 4 weeks. Results: Efficacy was very high, with 1,957 patients (98%) reporting satisfaction regarding blood loss control and prolapse reduction. The procedure was well tolerated: 1,838 patients (92%) presented mild/no pain. Objective reduction of prolapse volume was documented in 86% of reobserved cases. Complications were rare and usually minor: only 3 cases of clinically significant bleeding (0.15%), 2 of whom were on dual antiplatelet therapy plus oral anticoagulation, 2 cases of rectal abscess, 8 hemorrhoid thromboses, and 1 urinary retention requiring catheter (0.7% severe complications). Conclusions: Treatment of internal hemorrhoids with polidocanol foam injected in high doses is very effective and safe for the control of blood loss and prolapse, even for patients on anticoagulation/antiplatelet treatment.

Short-Term Results of Sclerotherapy with 3% Polidocanol Foam for Symptomatic Second- and Third-Degree Hemorrhoidal Disease

“…Recently, Fernandes et al [27] evaluated 2.000 consecutive patients, with II-IV degree HD, treated with polidocanol 2%. The authors reported a 98% success rate.…”

Sclerotherapy with 3% polidocanol foam: revolutionizing outpatient treatment in patients with haemorrhoidal disease

“…We cannot agree with the authors. In fact, there are several studies in the literature, even if still very heterogeneous, which reported the results of polidocanol foam in the treatment of all stages of HD [ 4 – 6 ].…”

“…Another case series that considered the use of foam for II–IV degree HD was published by Fernandes and colleagues in 2019 [ 6 ]. The authors enrolled 2000 consecutive patients reporting a 98% success rate.…”

Polidocanol sclerotherapy for multiple gastrointestinal hemangiomas: A case report

“…Complications of ESD treatment include bleeding, perforation, subcutaneous emphysema, and infection; thus, other feasible minimally invasive treatment methods should be actively attempted. In the treatment of GI hemangioma, Fernandes and Fonseca reported a clinical study on the treatment of internal hemorrhoids with a large dose of 2% polidocanol, which successfully reduced the rebleeding rate[ 5 ]. Igawa et al [ 6 ] reported a clinical case of a small intestinal hemangioma successfully treated with single-point injection of polidocanol, and the amount of polidocanol was calculated according to the surface area of the hemangioma.…”