The novel BPRST classification for hemorrhoidal disease: A cohort study and an algorithm for treatment

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.