Abstract
BackgroundWhether different embolic particles with comparable diameter lead to similar beneficial effects in endovascular embolization of hemorrhoidal disease remains to be established. We sought to evaluate the efficacy and safety of different types of agents for superior rectal arterial embolization (SRAE) in patients with bleeding hemorrhoids.MethodsPatients with recurrent episodes of internal hemorrhoidal bleeding and chronic anemia treated by SRAE in three tertiary hospitals between March 2017 and June 2020 were retrospectively evaluated. The patients were divided into two study groups based on the embolic materials: embolization with coils (2–3 mm) + gelfoam particles at 350–560 μm (Group A, n = 23), embolization with coils (2–3 mm) + microparticles at 300–500 μm (Group B, n = 18). The technical success, preliminary clinical efficacy (percentage of patients without hematochezia), postoperative complications and short-term follow-up outcomes were analysed.ResultsA total of 41 patients (27 males) with symptomatic hemorrhoids were included in the study, mean age was 47 ± 12 years (range 25–72). 39% (16) patients with grade II hemorrhoids while 61% (25) patients with grade III. The technical success rate of the embolization procedure was 100%, and the preliminary clinical efficacy (87.0% vs 88.9%) showed no significant difference between the 2 groups (p = 0.098). No patients reported post-procedural and short-term serious complications, such as infection, intestinal ischemia or massive hemorrhage during the follow-up period (range 6–15 months).ConclusionsBoth gelfoam particles and microparticles with comparable diameter in the endovascular treatment of hemorrhoidal bleeding demonstrated similarly good short-term efficacy and safety profile.
Highlights
Whether different embolic particles with comparable diameter lead to similar beneficial effects in endovascular embolization of hemorrhoidal disease remains to be established
In 1995, the Doppler-guided haemorrhoid artery ligation (DG-HAL) technique was first used by Morinaga to treat grade II–III internal hemorrhoids [2]
Vidal had attempted this endovascular embolization of the superior hemorrhoidal artery (SRA) in 2014, procedure known as “emborrhoid” and which is itself a technique based on pathophysiological characteristics of arteriovenous network hypertrophy in Hemorrhoidal disease (HD) and transanal dearterialization and ligation of the hemorrhoidal arteries [5], and the preliminary findings are encouraging [6]
Summary
Whether different embolic particles with comparable diameter lead to similar beneficial effects in endovascular embolization of hemorrhoidal disease remains to be established. The rapid development of interventional devices and embolization techniques provides a new method for the therapy of vascular diseases that were previously managed using more aggressive surgical approach. On this basis, Vidal had attempted this endovascular embolization of the SRA in 2014, procedure known as “emborrhoid” and which is itself a technique based on pathophysiological characteristics of arteriovenous network hypertrophy in HD and transanal dearterialization and ligation of the hemorrhoidal arteries [5], and the preliminary findings are encouraging [6]. The “emborrhoid” technique has been proven as a good alternative treatment method for internal hemorrhoidal bleeding, especially for patients with surgical contraindications or refusing conventional hemorrhoidectomy [1, 6,7,8,9,10]
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