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The novel BPRST classification for hemorrhoidal disease: A cohort study and an algorithm for treatment
Carlos Walter Sobrado1, Carlos de Almeida Obregon1, Lucas Faraco Sobrado1
1Colorectal Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil.
Insights
The new BPRST classification for hemorrhoids (HD) is more effective than Goligher's for guiding treatment. This study proposes a new algorithm to manage hemorrhoid disease based on the BPRST system.
Area of Science:
- Colorectal Surgery
- Gastroenterology
- Surgical Innovation
Background:
- The existing Goligher classification for hemorrhoids (HD), established in 1980, has limitations in addressing critical disease aspects for effective treatment guidance.
- Current clinical practice requires a more comprehensive classification system to accurately assess hemorrhoid severity and inform therapeutic decisions.
Purpose of the Study:
- To implement and evaluate the novel BPRST (bleeding, prolapse, reduction, skin tags, thrombosis) classification for hemorrhoids in a clinical setting.
- To compare the efficacy of the BPRST classification against the traditional Goligher classification in guiding hemorrhoid treatment.
- To develop and propose a treatment algorithm based on the BPRST classification for managing hemorrhoid disease.
Main Methods:
- A prospective study was conducted involving patients with hemorrhoids treated between March 2011 and July 2013.
- Patients were classified using both the Goligher and BPRST systems.
- Treatment decisions were based on clinical expertise and current guidelines, with comparisons made between classification systems and chosen treatments.
Main Results:
- 229 patients were included; 28 were lost to follow-up. The BPRST classification showed a stronger correlation with treatment selection compared to the Goligher classification (p < 0.001).
- Six patients initially classified under Goligher I were re-staged to BPRST III, necessitating conventional hemorrhoidectomy due to thrombosis or significant skin tags.
- The BPRST system demonstrated fewer outliers, indicating a more precise stratification of hemorrhoid severity relevant to treatment.
Conclusions:
- The Goligher classification presents significant limitations for practical clinical application in hemorrhoid management.
- The BPRST classification offers a more detailed assessment, incorporating key factors crucial for selecting optimal treatment strategies for hemorrhoids.
- The developed treatment algorithm, utilizing the BPRST classification, provides a structured approach to guide the management of complex hemorrhoid cases.
Background:
The classification for HD was developed by Goligher in 1980 and does not contemplate important aspects of this disease, which limits its use in guiding treatment. The aim of this study if to apply in clinical practice the new classification for hemorrhoids named BPRST (bleeding, prolapse, reduction, skin tags, thrombosis), to compare it with the original classification proposed by Goligher and to propose an algorithm for treatment.
Materials And Methods:
This is a prospective study conducted at the University of São Paulo's teaching hospital and Hospital 9 de Julho. Patients with HD treated from March 2011 to July 2013 were included. Patients were classified according to BPRST and Goligher classifications and treated according to personal experience and most updated guidelines. The association between both classifications and the treatment adopted was compared and an algorithm for treatment was developed.
Results:
229 patients were included in this study and 28 patients were lost due to follow-up. According to Goligher, 29, 61, 85 and 26 were classified as grades I, II, III and IV, respectively. According to the BPRST, 23 were classified as stage I, 95 as stage II and 83 as stage III. Six patients classified as Goligher I were reclassified as BPRST stage III and required conventional hemorrhoidectomy, either due to thrombosis (n = 4) or intolerable skin tags (n = 2). The BPRST classification was more closely associated with the type of treatment employed and had few outliers than Goligher (p < 0.001).
Conclusion:
There are limitations to the use of Goligher's classification in clinical practice. The novel BPRST classification includes important aspects of HD that should be considered when deciding the best treatment option. Our algorithm for treatment contemplates the most commonly used techniques and can help to guide the treatment of this complex disease.
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