Arterial Embolization for the Internal Hemorrhoids Management: A Systematic Review

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Gastroenterology

Background:

• Hemorrhoids are the most common benign anorectal condition globally, affecting up to 11% of the population.
• Symptoms include pain, bleeding, and discomfort, yet hemorrhoids are often underdiagnosed and poorly managed.
• Endovascular artery embolization presents a novel therapeutic approach for hemorrhoidal management.

Purpose of the Study:

• To systematically review the efficacy of endovascular artery embolization for hemorrhoids.
• To evaluate clinical outcomes and morbidity associated with this interventional procedure.
• To assess the impact of embolization on patient quality of life and symptom recurrence.

Main Methods:

• A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and Embase up to August 2022.
• Included studies underwent rigorous data extraction and quality assessment using the PRISMA 2020 checklist.
• Two independent reviewers screened studies, excluding reviews, non-English articles, and case reports.

Main Results:

• Fifteen studies were included, involving patients aged 40.5-72.2 years, with a majority being male (57.89%).
• Superior rectal artery embolization was performed in 424 patients, primarily using coils or microcoils.
• No major complications or deaths were reported in most studies; common adverse events included pain, tenesmus, and bleeding. Symptom recurrence requiring re-embolization or surgery occurred in 11.79% of patients.

Conclusions:

• Rectal artery embolization is a novel and effective treatment for internal hemorrhoids, demonstrating good clinical efficacy.
• The procedure is associated with minimal significant complications and leads to improved quality of life scores.
• Embolization effectively reduces bleeding scores, offering a promising alternative for hemorrhoid management.