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Sclerotherapy for III- and IV-degree hemorrhoids: Results of a prospective study
Giorgio Lisi1, Paolo Gentileschi2, Domenico Spoletini1
1Department of Surgery, Sant'Eugenio Hospital, Rome, Italy.
Insights
Sclerotherapy effectively treats severe bleeding hemorrhoids when surgery is delayed. This outpatient procedure offers a high success rate, with many patients opting for repeat treatment over surgery.
Area of Science:
- Anorectal surgery
- Gastroenterology
- Minimally invasive procedures
Background:
- Anorectal surgery scheduling has been significantly impacted, necessitating conservative treatments for conditions like bleeding hemorrhoids.
- Patients with III- and IV-degree bleeding hemorrhoids were considered for conservative management due to surgical delays.
Purpose of the Study:
- To assess the efficacy of sclerotherapy for patients with advanced-stage bleeding hemorrhoids who postponed surgical intervention.
- To evaluate sclerotherapy as a viable alternative to surgery in a challenging clinical scenario.
Main Methods:
- Outpatient sclerotherapy was administered to 19 patients diagnosed with III- and IV-degree bleeding hemorrhoids.
- Patient outcomes were assessed using the visual analog scale and hemorrhoid severity score, with follow-up evaluations at 1 week, 1 month, and 1 year post-procedure.
Main Results:
- The study included 19 patients (63% with Grade III, 37% with Grade IV hemorrhoids).
- Sclerotherapy demonstrated an 84% success rate at six months, with minimal complications.
- Despite initial success, persistent bleeding was reported by all patients by the study's end, leading 58% to opt for repeat sclerotherapy instead of surgery.
Conclusions:
- Sclerotherapy using 3% polidocanol foam is a safe and effective treatment for severe bleeding hemorrhoids.
- Further research is needed to evaluate the long-term efficacy and durability of foam sclerotherapy.
Background:
In 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.
Methods:
We 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.
Results:
From 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.
Conclusion:
Sclerotherapy 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.
