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Sclerotherapy for hemorrhoidal disease: systematic review and meta-analysis
G Gallo1, A Picciariello2, C Armellin3
1Department of Surgery, Sapienza University of Rome, Rome, Italy. ga.gallo@uniroma1.it.
Insights
Sclerotherapy is a safe and effective treatment for hemorrhoidal disease (HD), showing comparable success rates and fewer complications than other methods. Further research is needed to optimize techniques and long-term outcomes.
Area of Science:
- Gastroenterology
- Colorectal Surgery
Background:
- Hemorrhoidal disease (HD) affects a significant portion of the population, necessitating evaluation of treatment options.
- Sclerotherapy is a minimally invasive procedure used for managing HD.
Approach:
- A systematic review and meta-analysis adhering to PRISMA 2020 guidelines was conducted.
- A comprehensive literature search identified 44 studies involving 9729 patients treated with sclerotherapy for HD.
- Random-effects meta-analyses assessed safety and efficacy outcomes from 14 randomized controlled trials.
Key Points:
- Sclerotherapy demonstrated non-inferiority to control interventions for success rates (RR 1.00) and recurrence rates (RR 1.11).
- The procedure was associated with significantly fewer complications compared to control interventions (RR 0.46).
- Polidocanol was the most frequently used sclerosing agent, often administered without pre-injection analgesia.
Conclusions:
- Sclerotherapy is a safe and effective treatment for hemorrhoidal disease, offering comparable efficacy to other approaches with a lower complication rate.
- The findings support sclerotherapy as a viable option for managing HD.
- Further investigation is recommended to refine sclerotherapy techniques and assess long-term results.
Background:
This systematic review and meta-analysis aimed to evaluate the safety and efficacy of sclerotherapy methods for hemorrhoidal disease (HD) over the past 40 years.
Methods:
The review followed the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A comprehensive literature search was conducted, including studies reporting the use of sclerotherapy in patients with HD. Study eligibility criteria were defined, and data were extracted independently by the authors. Random-effects meta-analyses were performed to assess outcomes of interest.
Results:
Out of 1965 records identified, 44 studies met the inclusion criteria, involving 9729 patients. The majority of studies were conducted in Japan, followed by the UK, Italy, and Portugal. The median age of participants was 52 years, and the majority were male. The Goligher grade distribution indicated varying degrees of HD severity. Sclerotherapy was predominantly administered through anoscopy, with polidocanol being the most commonly used agent. The procedure was generally performed without pre-injection analgesia. The meta-analysis of 14 randomized controlled trials (RCTs) revealed that sclerotherapy was not inferior to control interventions in terms of success rate (risk ratio [RR] 1.00, 95% CI 0.71-1.41) and recurrence rate (RR 1.11, 95% CI 0.69-1.77), while resulting in fewer complications (RR 0.46, 95% CI 0.23-0.92).
Conclusions:
This systematic review highlights the safety and efficacy of sclerotherapy for HD, which yields similar success rates and fewer complications compared to other conservative or surgical approaches. Further research is warranted to optimize sclerotherapy techniques and evaluate long-term outcomes.
Registration:
PROSPERO 2023 CRD42023396910.
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