Abstract No. 50 Hemorrhoid embolization: a meta-analysis of the Emborrhoid technique

Abstract

To perform a systematic review and meta-analysis of published literature to evaluate the safety and efficacy of the emborrhoid technique in the treatment of hemorrhoids. The PUBMED (including articles indexed by MEDLINE) and COCHRANE databases were searched until August 2020 for retrospective and prospective studies that included patients with hemorrhoids treated with endovascular embolization using the emborrhoid technique. Exclusion criteria included studies that did not have an English language version available, did not report clinical outcomes data, involved a sample size of < 10, had an emergent indication for embolization, had data included in subsequent articles, or involved a pediatric or adolescent population. Technical success was defined as occlusion of all target branches of the superior rectal artery (SRA) supplying the hemorrhoid, while clinical success was defined as lack of significant rebleeding after the embolization. 8 studies were identified, consisting of 208 patients (128 men and 80 women) with an average age of 50.2 years. A variety of indications for minimally invasive surgery were covered in the studies including 1) contraindications for surgery, 2) patient refusal of surgery, and 3) persistent hemorrhoids. Technical success rates from the studies averaged 98.1%, while clinical success rates averaged 85.3%. 3 studies reported an average median change in French Bleeding Severity Score of -2.91. The compiled complication rate of cases averaged 3.34%, with 6 studies reporting 0 complications. Complications that were reported include access site complications, perianal reactions, and a number of grade 1 complications. Notably, no studies reported any change in rates of rectal ulceration, anal fissures, or prolapse. All studies reported follow-up periods, the median follow-up being 6.5 months across a range of 1-18 months. Embolization of hemorrhoids through minimally invasive technique is a technically feasible, safe, and effective treatment. Future studies of the “emborrhoid” technique should focus on standardization of reported outcome measures.