Scoring systems as outcomes assessment of the treatments for haemorrhoidal disease: a systematic review of the literature

Longchamp, Grégoire; Liot, Émilie; Meyer, Jérémy; Longchamp, Alban; Toso, Christian; Buchs, Nicolas; Ris, Frédéric

doi:10.1007/s00384-020-03603-0

Cited by 3 publications

(1 citation statement)

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“…As a result, meaningful comparisons between treatment methods have been difficult, and this is reflected in variations in current clinical practice. Moreover, the Goligher classification, an anatomic-based classification, is inadequate to optimally assess and treat hemorrhoids as others have reported [33,34]. In clinical practice, prolapsed hemorrhoids can become morphologically mixed, achieving an overlap between internal and external, which the Goligher classification does not consider, nor does it consider symptoms, which do not depend on hemorrhoidal size.…”

Section: Current Challenges In Research and Future Directionsmentioning

confidence: 99%

Endoscopic approaches to the management of hemorrhoids

Kodilinye

Kalloo

2023

Current Opinion in Gastroenterology

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Purpose of review To review the literature within the last 5 years on the current status and future perspectives of the endoscopic management of internal hemorrhoids. Recent findings Despite the large burden of hemorrhoidal diseases, research in this area, particularly on endoscopic approaches for treatment, has been slow. Within the last 5 years, data has been published on the novel cap-assisted endoscopic sclerotherapy (CAES), which will continue to gain attention in the future. Rubber band ligation has been adopted by the endoscopist as endoscopic rubber band ligation (ERBL), demonstrating satisfactory results in treating symptomatic hemorrhoids, although mild postprocedure complications are common. Data is needed on head-to-head comparisons between ERBL, endoscopic sclerotherapy, and CAES. Other methods, such as coagulation, are understudied and should be explored further in the endoscopic setting. Meaningful comparisons between treatment methods for internal hemorrhoids have been difficult because of variations in interventional techniques and methods, differences in the grading of hemorrhoids, and lack of standardization of clinical trials. The Goligher classification alone is inadequate for determining the management of symptomatic hemorrhoids and this warrants revision. Summary Gastroenterologists are poised to assume a greater role in the management of internal hemorrhoids with flexible endoscopy. Current endoscopic treatment options require further study.

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Section: Current Challenges In Research and Future Directionsmentioning

confidence: 99%

Endoscopic approaches to the management of hemorrhoids

Kodilinye

Kalloo

2023

Current Opinion in Gastroenterology

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Non-excisional laser therapies for hemorrhoidal disease: a systematic review of the literature

et al. 2020

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Non-excisional laser therapies are emerging treatment for grades II and III hemorrhoidal disease (HD). However, so far, their efficiency is based on low-level evidence. Therefore, we aimed to systematically review the efficiency of non-excisional laser therapies for HD. MEDLINE/Pubmed, Web of science, Embase, and Cochrane were searched from database implementation until the April 17th, 2020. We included studies reporting at least one of surgical indicators of postoperative outcomes of laser therapies, encompassing laser hemorrhoidoplasty (LH) and hemorrhoidal laser procedure (HeLP). Fourteen studies describing LH and HeLP were included, representing 1570 patients. The main intraoperative complication was bleeding (0–1.9% of pooled patients for LH, 5.5–16.7% of pooled patients for HeLP). Postoperative complications occurred in up to 64% of patients after LH and 23.3% after HeLP. Resolution of symptoms ranged between 70 and 100% after LH and between 83.6 and 90% after HeLP. Moreover, four randomized controlled trials included in our review reported similar resolution after LH compared with hemorrhoidectomy or mucopexy and after HeLP compared with rubber band ligation. Recurrence rate was reported to range between 0 and 11.3% after LH and between 5 and 9.4% after HeLP. When compared with hemorrhoidectomy, LH showed conflicting results with one randomized controlled trial reporting similar recurrence rate, but another reporting decreased recurrences associated with hemorrhoidectomy. Laser therapies showed lower postoperative pain than hemorrhoidectomy or rubber band ligation. LH and HeLP are safe and effective techniques for the treatment of grades II and III HD.

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