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

Abstract

Background: Hemorrhoidal disease (HD) is defined as the symptomatic enlargement and/or distal displacement of anal cushions and is one of the most common proctological diseases. Sclerotherapy (ST) with 3% polidocanol foam induces an inflammatory reaction with sclerosis of the submucosal tissue and consequent suspension of the hemorrhoidal tissue. The aim of this study was to evaluate the short-term effectiveness and safety of ST with 3% polidocanol foam for the treatment of symptomatic second-and third-degree HD. Methods: A total of 66 patients with symptomatic second-and third-degree HD underwent a single ST session between March 2017 and July 2018. A visual analog scale score was used to assess post-operative pain and patient satisfaction. The symptoms severity and anal continence were investigated through the Hemorrhoid Severity Score (HSS) and Vaizey score, respectively, at baseline, at 4 weeks and after 1 year. Results: Fifty-seven out of 66 patients were male (86.3%), and the mean age was 52 (29-75; SD ± 12) years. The mean operative time was 4.5 (2-6; SD ± 1.23) minutes. No intraoperative complications and no drug-related side effects occurred. The overall success rate was 78.8% (52/66 patients) after a single ST session and 86% after two ST sessions (57/66 patients). The mean treatment effect, obtained comparing preoperative and 12 months symptom scores in each patient, showed a median change of 8 (p < 0.001). All patients resumed their normal daily activities the day after the procedures. Conclusions: ST with 3% polidocanol foam is a safe, cost-effective and repeatable conservative treatment.

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

“…These results were consistent with a recent retrospective study [ 5 ], concerning the use of 3% polidocanol foam in 66 patients with II- and III- degree HD, in which the overall success rate after a single session was 78.8% and only 9 patients experienced a median post-operative pain of 4. There was no statistically significant difference between II- and III-degree HD in terms of success rate and complications.…”

“…Regarding the former, there is a huge difference based on the approach. For the endoscopic approach, a 23G needle [ 4 ] is often used while for the transanal approach, the ideal is a 20G needle [ 5 ].…”

“…As regards the amount of foam, according to the above-mentioned studies [ 3 – 5 ], 2 cc per pile with a maximum of 6–8 cc for the whole procedure is the best solution. We suggest producing a foam according to the Tessari method that has a ratio of 1.6 ml of liquid polidocanol to 7.4 ml of air.…”

Evolution of Surgical Management of Hemorrhoidal Disease: An Historical Overview

“…In 2007, sclerotherapy received a new impetus with the introduction of 3% polidocanol foam as a sclerosing agent by Moser (75). Since then, several studies have shown the superiority of foam in terms of effectiveness and reduced complications compared with oil-based agents, inaugurating a new era for sclerotherapy (76)(77)(78)(79). However, these studies mainly focused on the treatment of 1-degree HD, while further studies are needed on 2-and 3-degree HD (79,80).…”

Polidocanol sclerotherapy for multiple gastrointestinal hemangiomas: A case report

“…In the treatment of GI hemangiomas, esophageal varices sclerotherapy, internal hemorrhoid sclerotherapy, and intestinal hemangioma sclerotherapy have been reported[ 4 - 6 ]. In a case of using sclerotherapy to control bleeding, it was mentioned that sclerotherapy with 3% polidocanol foam induces an inflammatory reaction with sclerosis of the submucosal tissue and consequent suspension of the hemorrhoidal tissue[ 7 ]. Markovic et al [ 8 ] reported that sclerotherapy in the treatment of low flow vascular malformations did not significantly change hemodynamic consequences and reduce complications.…”