Sclerotherapy for III- and IV-degree hemorrhoids: Results of a prospective study

Abstract

BackgroundIn the last 2 years, anorectal surgery has been strongly affected and even surgery for urgent cases cannot be scheduled; also, patients with III- and IV-degree bleeding hemorrhoids should be treated conservatively. The aim was to evaluate the effectiveness of sclerotherapy in patients who had to postpone surgery.MethodsWe included all patients with III- and IV-degree bleeding hemorrhoids who underwent outpatient sclerotherapy. The visual analog scale and the hemorrhoid severity score were used at the baseline and at 4 weeks after the procedure with a telephone interview, and all patients were outpatient-evaluated 1 week, 1 month, and 1 year after the treatment. All pre- and postoperative data were recorded.ResultsFrom October 2020 to November 2021, 19 patients with III- (12 patients; 63%) and IV-degree (7 patients; 37%) bleeding hemorrhoids were enrolled. The mean operative time was 4.5 min, and no intraoperative complications occurred. One case of tenesmus and three failures were detected. Six months after the procedure, the overall success rate was 84%, although all of the patients enrolled reported persistent bleeding at the end of the study period. Of these, 5 patients (26%) were scheduled for surgery and 11 patients (58%) refused surgery and asked to undergo a re-do sclerotherapy.ConclusionSclerotherapy with 3% polidocanol foam is a safe and effective procedure also in III- and IV-degree bleeding hemorrhoids. The long-term data on the length of the foam remain to be evaluated in additional studies.

Sclerotherapy for hemorrhoidal disease: systematic review and meta-analysis

“…These studies included 17 RCTs [ 3 , 14 , 20 – 34 ], 1 case–control study [ 35 ], and 26 cohort studies (Table 1 ). The majority of the studies were conducted in Japan ( n = 9) [ 8 , 35 – 42 ], followed by the UK ( n = 6) [ 20 – 23 , 43 , 44 ], Italy ( n = 6) [ 12 , 45 – 49 ], and Portugal ( n = 4) [ 3 , 33 , 50 , 51 ]. Six (14%) of the studies were multicenter [ 14 , 35 , 41 , 47 , 51 , 52 ].…”

“…The needle’s caliber ranged between 20 and 25 gauge in 14 (32%) studies. Tessari’s method [ 57 ] was used to prepare the foam of polidocanol in nine studies [ 3 , 12 , 14 , 33 , 46 , 47 , 49 – 51 ], and the Varixio system in one study [ 48 ].…”

Hemorrhoidal Disease: How to Proceed After Unsuccessful Medical Treatment?

“…The sclerosing agent causes inflammation and scarring of hemorrhoids, leading to its shrinkage and eventual resolution. Indications for sclerotherapy in hemorrhoids include first-and second-degree internal hemorrhoids that are bleeding, prolapsing, or causing discomfort [38]. The procedure benefits patients with mild to moderate symptoms who do not respond to conservative measures such as dietary changes and topical medications.…”

Prevalent Technique and Results of Hemorrhoidal Embolization

“…RBL appears to be more efficient in symptom resolution than SCL; nonetheless, SCL causes less postprocedural pain and minor complications. Some authors propose SCL as a first-line therapy and RBL for recurrent disease [14][15][16]. THD and DGHAL are minimally invasive techniques, with the same rationale as HE.…”

“…However, 10% of all patients will need surgery such as conventional hemorrhoidectomy (CH) [9], circular anopexia [10], or stapled hemorrhoidopexy (SH) [11]. Over the years, less invasive techniques such as rubber band ligation (RBL) [12,13], sclerotherapy (SCL) [14][15][16], and infrared coagulation have been developed, allowing an outpatient setting and a quicker patient recovery, despite an increased recurrence. Recently, minimally invasive techniques based on the hyperflow of hemorrhoidal arteries, such as transanal hemorrhoidal dearterialization (THD) [17], doppler-guided hemorrhoidal artery ligation (DGHAL) [18,19], or its endovascular version, the "Emborrhoid technique" [20,21], have emerged, showing promising results and more patient comfort (Table 3) [22].…”