Symptomatic Internal Hemorrhoids Research Articles

Endoscopic polidocanol foam sclerobanding for the treatment of grade II-III internal hemorrhoids: A prospective, multi-center, randomized study.

Endoscopic rubber band ligation (ERBL) is a nonsurgical technique for the treatment of symptomatic internal hemorrhoids but is limited by recurrence and post-procedural pain. To evaluate satisfaction, long-term recurrence, and post-procedural pain in managing internal hemorrhoids using a combination of polidocanol foam sclerotherapy and ERBL. This was a prospective, multicenter, randomized study. A total of 195 consecutive patients diagnosed with grade II-III internal hemorrhoids were enrolled from four tertiary hospitals and randomly divided into a cap-assisted endoscopic polidocanol foam sclerobanding (EFSB) or an ERBL group. All patients were followed-up for 12 months. Symptom-based severity and post-procedural pain were assessed using a hemorrhoid severity score (HSS) and a visual analog scale (VAS). Continuous variables were reported as medians and interquartile range. One hundred and ninety-five patients were enrolled, with 98 in the EFSB group. HSS was lower in the EFSB group than in the ERBL group at 8 weeks [4.0 (3.0-5.0) vs 5.0 (4.0-6.0), P = 0.003] and 12-month [2.0 (1.0-3.0) vs 3.0 (2.0-3.0), P < 0.001] of follow-up. The prolapse recurrence rate was lower in the EFSB group at 12 months (11.2% vs 21.6%, P = 0.038). Multiple linear regression analysis demonstrated that EFSB treatment [B = -0.915, 95% confidence interval (CI): -1.301 to -0.530, P = 0.001] and rubber band number (B = 0.843, 95%CI: 0.595-1.092, P < 0.001) were negatively and independently associated with the VAS score 24 hours post-procedure. The median VAS was lower in the EFSB group than in the ERBL [2.0 (1.0-3.0) vs 3.0 (2.0-4.0), P < 0.001]. Cap-assisted EFSB provided long-term satisfaction and effective relief from the recurrence of prolapse and pain 24 hours post-procedure.

Outcome of Haemorrhoidal Artery Ligation and Recto Anal Repair (HAL-RAR) with Doppler Guidance for Symptomatic Grade-II, III and IV Internal Haemorrhoids

Background: Internal haemorrhoids are very common all around the world and the classical surgical treatment is open haemorrhoidectomy for a long time. This procedure has a lot of complications and is very painful for the patient. Doppler guided HAL-RAR has shown satisfactory results in the literature with minimal pain and a significantly lower rate of complications compared to open haemorrhoidectomy .&#x0D; Objective: To assess the outcome of a relatively new surgical procedure (HAL-RAR) using doppler guidance for the treatment of grade-II, III and IV internal haemorrhoids.&#x0D; Methods: This case series was conducted at Surgimed hospital, Lahore, Pakistan, between May 2015 to December 2021. One hundred patients who attended the outpatient department of the hospital were recruited for this study. These patients presented with grade-II, III or IV symptomatic internal haemorrhoids. Surgical intervention in the form of HAL-RAR was performed in all patients and outcome was measured in terms of mean operating time, length of hospital stays, post-operative pain, recurrence of prolapse and bleeding, and early and late post-operative complications with one year follow up for all patients. &#x0D; Results: Out of these 100 patients, 72 were males and 28 were females. On average, seven haemorrhoidal artery ligations and three recto anal repairs were performed in each patient. The average hospital stay was 31 hours with a range between 24 hours to 72 hours. Early post-operative pain was minimum and only twelve patients required narcotic analgesics. Three patients complained of excessive pain lasting for five days. Seven patients had self-limiting bleeding, two patients had post-operative bleeding which was controlled by re-ligation of the bleeding point and one patient developed a perianal fistula. In the long term follow up, one patient had recurrence of prolapse six months after the surgery. &#x0D; Conclusion: HAL-RAR with doppler was a safe and efficient method for treatment of grade-II, III and IV internal haemorrhoids, with very low post-operative pain scores, satisfactory relief of symptoms, and low recurrence rates.&#x0D;

HEmoRhoidal disease management with Band ligation versus polidocanol Sclerotherapy: a systematic review and meta-analysis (the HerBS Review).

Symptomatic internal hemorrhoids affect up to 40% of people in Western society. Patients with grade I-III hemorrhoids, who fail lifestyle and medical management, may benefit from office-based procedures. As per the American Society of Colon and Rectum Surgeons (ASCRS), rubber band ligation (RBL) is the first-line office-based treatment. Polidocanol sclerotherapy is a relatively new approach for these patients. The aim of this systematic review is to compare the efficacy of RBL and polidocanol sclerotherapy with the treatment of symptomatic grade I-III internal hemorrhoids. The systematic review was completed by searching MEDLINE, Embase, and CENTRAL databases from inception to August 2022 for prospective studies comparing RBL and polidocanol sclerotherapy or evaluating the efficacy of polidocanol sclerotherapy alone for adult (> 18years) patients with grade I-III internal hemorrhoids. Treatments were evaluated for therapeutic success and post-procedure morbidity. Of 155 citations obtained, 10 studies (3 comparative and 7 single-arm studies) and 4 abstracts (2 comparative and 2 single arm) were included in the study. The patients undergoing sclerotherapy had a 93% (151/163) therapeutic success rate compared to 75% (68/91) in the RBL group (OR 3.39, 95% CI 1.48-7.74, p < 0.01). The post-procedure morbidity was 8% (17/200) in the sclerotherapy group and 18% (23/128) in the RBL group (OR 0.53, 95% CI 0.15-1.82, p = 0.31). This study highlights that polidocanol sclerotherapy may be associated with higher therapeutic success in patients with symptomatic grade I-III internal hemorrhoids. Further evaluations in the form of randomized trials are required to evaluate patient populations, which may benefit more from sclerotherapy.

Outcomes of Hemorrhoidal Artery Embolization from a Multidisciplinary Outpatient Interventional Center

PurposeTo evaluate the safety and efficacy of outpatient transarterial embolization for symptomatic refractory internal hemorrhoids. Materials and MethodsRetrospective analysis of 134 patients who underwent hemorrhoidal artery embolization (HAE) for symptomatic internal hemorrhoids between August 2021 and June 2022 (76 men and 58 women) was performed. The mean age was 54.9 years, with a mean Goligher hemorrhoid grade (HG) of 2.1. Branches of the superior rectal artery (SRA) or middle rectal artery supplying the corpus cavernosum recti were embolized with both spherical particles and microcoils. Standard-of-care evaluations were performed at baseline and the 1 month follow-up, which included hemorrhoid-related pain (HRP) (0–10), hemorrhoid symptoms score (HSS) (5–20), quality of life (QoL) (0–4), French bleeding score (FBS) (0–9), and HG (0–4). Clinical success was defined as improvement of symptoms without additional treatment. ResultsEmbolization of at least 1 hemorrhoidal artery was achieved in 133 (99%) of the 134 patients. The mean number of SRA branches embolized per patient was 2.9 ± 1.0. Clinical success was seen in 93% (124 of 134) of patients at the 1-month follow-up, with 10 patients requiring repeat embolization. There were significant improvements in all mean outcomes at 1 month: HSS (11–7.8; P < .01), HRP (4.1–1.3; P < .01), QoL (2.2–0.8; P < .01), FBS (4.4–2.2; P < .01), and HG (2.3–1.2; P < .05). There were no severe adverse events. ConclusionsHAE is a safe and effective outpatient treatment for refractory symptomatic internal hemorrhoids in the short term.

Long-term efficacy and safety of cap-assisted endoscopic sclerotherapy with long injection needle for internal hemorrhoids.

Hemorrhoids are a common anal condition and can afflict an individual at any age. Epidemiological survey results in China show that the prevalence of anorectal diseases is as high as 50.1% among which 98.08% of patients have hemorrhoid symptoms. To assess long-term efficacy and safety of cap-assisted endoscopic sclerotherapy (CAES) with long injection needle for internal hemorrhoids. This study was retrospective. Data from patients with symptomatic internal hemorrhoids treated with CAES using endoscopic long injection needle from April 2016 to December 2019 were collected. Patients were telephoned and followed at two time points, December 2020 and 2021, to evaluate the improvements in symptoms, complications, recurrence, and satisfaction. Two hundreds and one patients with internal hemorrhoids underwent CAES with the long needle. The first median follow-up was performed 33 mo post-operatively. Symptoms improved in 87.5% of patients after the first CAES. Efficacy did not decrease with treatment time extension. Fifty-four patients underwent colonoscopy after the first CAES treatment of which 21 underwent CAES again, and 4 underwent hemorrhoidectomy. At the first follow-up, 62.7% of patients had both improved hemorrhoid grades and symptoms, and 27.4% had a significant improvement in both parameters. At the second follow-up, 61.7% of the patients showed satisfactory improvement in their hemorrhoid grade and symptoms when compared with pre-surgery values. 90% of patients reported CAES was painless, and 85% were satisfied/very satisfied with CAES treatment outcomes. The present study based on the largest sample size reported the long-term follow-up of the treatment for internal hemorrhoid with the CAES using endoscopic long injection needle. Our findings demonstrate that CAES should be a micro-invasive endoscopic technology yields satisfactory long-term efficacy and safety.

S651 Safety and Efficacy of Hemorrhoidal Artery Embolization in Patients Refractory to Conservative Management

Introduction: Endovascular hemorrhoidal artery embolization has emerged as an analogous therapy to Doppler-guided ligation. The purpose of this study was to evaluate the safety and efficacy of outpatient transarterial embolization for symptomatic refractory internal hemorrhoids. Methods: One hundred and twenty-six patients with symptomatic bleeding internal hemorrhoids refractory to prior treatment (e.g., banding, dietary/lifestyle modifications) were treated between August 2021 and May 2022 (62 men and 64 women). The average age was 58.3 +/- 15.8 years with an average Goligher's hemorrhoid grade of 2.2. Patients underwent superior and/or middle rectal artery embolization to the target arteries demonstrating abnormal vascular blush of the hemorrhoidal cushion with spherical embolic particles (500 or 600 micron) and/or microcoils (2-6 mm). Patients were discharged two hours post-procedure and were evaluated at baseline and 1-month for the following standardized outcomes: hemorrhoid related pain (HRP, 0-10), hemorrhoid symptoms score (HSS, 5-20), quality of life (QoL, 0-4), French bleeding score (FBS, 0-9), and hemorrhoid grade (0-4). Results: Femoral (121/126) or radial access (5/126) was performed and successful embolization of the superior and/or middle rectal artery was achieved in 126/126 (100%) patients. Statistically significant improvements in all outcomes were reported at follow-up (baseline vs 1 month): HRP (4.6 vs 1.7, p < 0.001), HSS (10.2 vs 7.1, p < 0.001), QoL (2.4 vs 0.7, p < 0.001), FBS (3.9 vs 1.5, p < 0.001), and hemorrhoid grade (2.0 vs 1.6, p = 0.03). One minor adverse event was reported: post-procedural peri-anal pain that required topical cream, which resolved soon after treatment. No major adverse events were reported. Conclusion: Hemorrhoidal artery embolization is a safe and effective outpatient treatment for refractory symptomatic internal hemorrhoids.

Sclerotherapy using 2 % polidocanol foam in the treatment of hemorrhoidal disease - a single-center experience.

Elastic banding and sclerotherapy are the two most commonly performed instrumental therapies in the treatment of symptomatic internal hemorrhoids. Promising results have been shown with sclerotherapy using 2 % polidocanol foam. The present study aimed to evaluate the efficacy and safety of polidocanol foam in the treatment of symptomatic internal hemorrhoids.

English

BACKGROUND Haemorrhoids are one of the most common anorectal conditions encountered in clinical practice and are recognised as a common cause of rectal bleeding, perianal itching and anal discomfort. Therapeutic treatment of haemorrhoids needs to be tailored according to grades and complication of haemorrhoids, patient preference and expertise of procedure. Very limited data is available regarding effectiveness of retrograde endoscopic injection sclerotherapy for the management of bleeding haemorrhoids. We wanted to study the effectiveness of retrograde endoscopic sclerotherapy (REST) for the management of various grades of bleeding internal haemorrhoids. METHODS A prospective study, included 87 patients with Gr. I, II and Gr. III symptomatic bleeding internal haemorrhoids. They were subjected to retrograde endoscopic sclerotherapy using Inj. Polidocanol to study its effectiveness in controlling bleeding. Effectiveness of the procedure was defined by stoppage of bleeding at 3 months follow up. RESULTS Bleeding stopped in 95.3 % cases after retrograde endoscopic sclerotherapy at 3 months follow up. No significant complications were observed with the procedure during the study period. CONCLUSIONS Retrograde endoscopic sclerotherapy is a safe, well tolerated and effective modality for the management of bleeding internal haemorrhoids. KEYWORDS Haemorrhoids, Retrograde Endoscopic Sclerotherapy

ROLE OF RUBBER BAND LIGATION AS A NON-INVASIVE TREATMENT IN HAEMORRHOID W.S.R. TO INTERNAL HAEMORRHOIDS

In the present modern age,the majority of people are suffering from haemorrhoids. Mithyaahara- Vihara (faulty food habits and improper sedentary lifestyle) has increased its incidence. Internal haemorrhoid is situated internal to anal orifice, starts at anorectal ring and ends at the dentate line. Haemorrhoidectomy either open or closed is an invasive procedure for the treatment of hemorrhoids. A non-invasive measure for the treatment of haemorrhoids is Rubber Band Ligation. In this method, internal haemorrhoids are tied off at its base with rubber bands to cutting off blood flow resulting in necrosis of the haemorrhoidal stump. It relies on the principle of mucosal fixation. In the present clinical study Rubber Band, Ligation was done in randomly selected 15 patients of either sex with internal haemorrhoids. The duration of the trial was of 15 days, with a follow-up of 4 weeks. The total effect of therapy was assessed based on Clinical &amp;Postoperative criteria. Statistical analysis has determined significance of the treatment. For all values significance level was p&lt;0.05. In proctorrhagia percentage relief was 77.7% and results were highly significant while in prolapse percentage relief was 66.6% and the results were highly significant.Rubber band ligation has the advantages of no requirement of anesthesia, minimal hospitalization, and less postoperative pain. Hence after clinical study, it can be concluded that Rubber Band Ligation is a timely accepted effective treatment modality for complete relief of symptomatic internal haemorrhoids. Through a non-invasive approach, it cures internal haemorrhoids without disturbing normal haemorrhoidal cushion.

A prospective study of the outcome of endoscopic haemorrhoidal ligation for symptomatic internal haemorrhoids

Aim: To evaluate the long-term outcome of endoscopic band ligation of symptomatic internal haemorrhoids. Methods: A total of 70 subjects fulfilling the inclusion criteria were included. After thorough history taking and proctoscopic examination, patients with symptomatic internal haemorrhoids were subjected to Endoscopic band ligation, and followed up at 2 weeks, 4 weeks, 2 months and 6 months, and assessed for pain, recurrence and bleeding. Results: The number of band ligations averaged 2.37 per subject. 4.3% of them experienced mild pain by 4 weeks, whereas the rest were free of pain. At the end of 6 months, 5.7% of subjects were still symptomatic and 8.6% had recurrent per rectal bleed. A total of 8.6% of subjects needed repeat ligation for alleviation of symptoms, and 1.4% needed definitive surgery. Conclusion: Endoscopic band ligation is a simple and effective procedure that can be carried out in symptomatic internal haemorrhoids on out-patient basis.

Comparative study of endoscopic band ligation versus injection sclerotherapy with 50% dextrose in water, in symptomatic internal haemorrhoids.

Haemorrhoids are common anorectal conditions seen in surgical practice, with various treatment modalities. This study compared the short-term outcome of injection sclerotherapy with 50% dextrose in water and rubber band ligation in the management of second-and third-degree haemorrhoids, in terms of symptoms improvement, complications, recurrence rate, retreatment rate and acceptability. This was a prospective comparative study that was carried out in the endoscopic unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, in southwestern Nigeria. Sixty consecutive patients with second- and third-degree haemorrhoids, who consented, were recruited into the study and were randomised into two groups. Group A had endoscopic injection sclerotherapy and Group B had endoscopic rubber band ligation. With regard to anal protrusion, more patients consistently reported either complete (16 [64.4%]) or partial (9 [40.9%]) resolution of symptoms in Group B, compared to Group A which had 7 (28.0%) and 5 (22.7%) cases, respectively (P = 0.03). Resolution of anal bleeding was initially more in Group B than A (22 [95.7%] vs. 17 [77.3%] patients, respectively), in the first 24-h post-treatment; however, within the 1st week, this ratio was reversed (P = 0.07). The retreatment rate for Group A and B was 23.3% and 13.3%, respectively,P = 0.34. More patients in Group B experienced severe pain post-treatment compared to Group A (P = 0.01). Three-month post-treatment, two (11.8%) patients in Group A and one (4.5%) in Group B had recurrence of anal bleeding (P = 0.42). There was no recurrence in anal protrusion in both treatment groups. Endoscopic rubber band ligation had a significantly higher success rate than endoscopic injection sclerotherapy, in terms of resolution of anal protrusion, but with higher pain score.

Hemorrhoid Banding: A Cost-Effectiveness Analysis

Hemorrhoid banding is an established treatment for symptomatic internal hemorrhoids with proven efficacy, low cost, and limited discomfort. Although the costs and quality of life following individual banding treatments have been investigated, little is known about cumulative cost and quality of life from sequential banding therapy or how these cumulative costs compare to surgical therapy. This study aimed to determine the cost-effectiveness of sequential hemorrhoid banding therapy. A retrospective review of historic banding treatment patterns was performed. Cost estimates and quality-of-life predictions were applied to observed treatment patterns in a decision-analytic cost-effectiveness model to compare sequential banding therapy with hypothetical surgical intervention. A retrospective billing record review for patients treated in a colorectal specialty clinic between 2012 and 2017 was performed. Patients initially treated with banding therapy for symptomatic internal hemorrhoids were included. The primary outcomes measured were hemorrhoid banding treatment patterns, cost-effectiveness, and net monetary benefit. Treatment of 2026 patients undergoing hemorrhoid banding identified 94% resolution with sequential banding and 6% requiring delayed surgical intervention. Average cumulative estimated cost for banding therapy was $723 (range, $382-$4430) per patient with an average quality-of-life deficit of -0.00234 (range, -0.00064 to -0.02638) quality-adjusted life-years. Estimates for hypothetical hemorrhoid artery ligation, stapled hemorrhoidopexy, or surgical hemorrhoidectomy found significantly higher cost (3.15×, 4.39×, and 2.75× more expensive) and a significantly worse quality-of-life deficit (1.55×, 5.64×, and 9.45× worse). For patients with persistent disease, continued sequential banding remained the dominant cost-effective therapy. This cost-effectiveness model relies on a retrospective review of billing records with estimated cost and quality of life. Hemorrhoid banding is a valuable treatment modality with favorable cost-effectiveness. The majority of patients selected for banding find resolution without surgery. For patients with persistent disease, further banding procedures remain cost-effective compared with delayed surgical therapy. See Video Abstract at http://links.lww.com/DCR/A982. UN ANÁLISIS DE COSTO-EFECTIVIDAD: La banda para hemorroides es un tratamiento establecido para las hemorroides internas sintomáticas con eficacia comprobada, bajo costo y malestar limitado. Si bien se han investigado los costos y la calidad de vida después de los tratamientos de bandas individuales, se sabe poco sobre el costo acumulativo y la calidad de vida de la terapia de bandas secuencial o cómo estos costos acumulativos se comparan con la terapia quirúrgica. Determinar el costo-efectividad de la terapia secuencial de bandas hemorroidales. DISEÑO:: Se realizó una revisión retrospectiva de la historia de los patrones de tratamiento con bandas. Las estimaciones de costos y las predicciones de la calidad de vida se aplicaron a los patrones de tratamiento observados en un modelo analítico de costo-efectividad para comparar la terapia de bandas secuencial con la intervención quirúrgica hipotética. Revisión retrospectiva de los registros de facturación de los pacientes tratados en una clínica de especialidad colorrectal entre 2012 y 2017. Pacientes tratados inicialmente con terapia de bandas para hemorroides internas sintomáticas. Patrones de tratamiento con bandas de hemorroides, costo-efectividad y beneficio monetario neto. El tratamiento de 2026 pacientes con bandas identificó una resolución del 94% con bandas secuenciales y el 6% requirió una intervención quirúrgica tardía. El costo promedio acumulado estimado para la terapia de banda fue de $ 723 (Rango: $382-$4430) por paciente con un déficit de calidad de vida promedio de -0.00234 (Rango: -0.00064 a -0.02638) años de vida ajustados por calidad. Las estimaciones para la hipotética ligadura de la arteria hemorroidal, la hemorroidopexia con grapas o la hemorroidectomía quirúrgica encontraron un costo significativamente mayor (3.15×, 4.39×, 2.75× más caro) y un déficit de la calidad de vida significativamente peor (1.55×, 5.64×, 9.45× peor). Para los pacientes con enfermedad persistente, la colocación de bandas secuenciales continuas siguió siendo la terapia rentable dominante. Este modelo de costo-efectividad se basa en una revisión retrospectiva de los registros de facturación con el costo y la calidad de vida estimados. Las bandas de hemorroides son una valiosa modalidad de tratamiento con una favorable relación costo-efectividad. La mayoría de los pacientes seleccionados para terapia con bandas encuentran resolución sin cirugía. Para los pacientes con enfermedad persistente, los procedimientos de colocación de bandas adicionales siguen siendo rentables en comparación con el tratamiento quirúrgico tardío. Vea el Resumen del video en http://links.lww.com/DCR/A982.

Association Between Hemorrhoids and Lower Extremity Chronic Venous Insufficiency.

AimThe aim of the present study was to evaluate the incidence of varicose veins among patients with hemorrhoidal disease and to compare its incidence reported in various community-based studies.MethodThe study group comprised of 100 patients who underwent surgery for symptomatic internal or external hemorrhoids; the control group consisted of 100 volunteers who received no prior therapy for hemorrhoidal disease and lacked any symptoms or findings suggestive of this condition. Subjects in both the groups were inquired with respect to their demographic data and risk factors. Both groups were asked to stand for two minutes before performing leg examinations while still in the standing position. The findings were recorded for both the groups. Varicose veins were classified according to the clinical appearance section of the Clinical, Etiologic, Anatomic, and Pathophysiologic (CEAP) classification that was developed by the 1994 American Venous Forum.ResultsThere was no significant difference between the two groups with respect to age and body mass index (BMI). Significant relationships were identified between the groups with respect to the incidence of varicose veins and chronic constipation. The incidence of C1 and C2 varicose veins observed in the study group was higher than that observed in the control group. The incidence of chronic constipation was higher in the study group than that in the control group.DiscussionLower extremity chronic venous insufficiency is more common in patients with hemorrhoidal disease which increases intra-abdominal pressure. A chronic increase in this pressure causes conditions, such as constipation, which trigger both lower extremity chronic venous insufficiency and hemorrhoidal disease.

The Elastic Ligation of Internal Hemorrhoids: Where Are We Now?

Hemorrhoidal disease requires different means of treatment: medical, surgical and instrumental. Among these, the elastic ligature seems to be an effective and widespread technique in the world. The aim of our study is to report our experience in methodology and short and medium term results of ligation in a population that strongly fears surgery. Patients and Methods: It’s about a retrospective and descriptive study of 208 outpatients treated with elastic ligations for symptomatic internal hemorrhoids. These patients were collected over a period of 15 years (October 2003-April 2018) at the gastroenterology department of Hassan II CHU in Fez. Results: The average age of our patients was 50.3 years [20 - 82 years] with a sex-ratio M/F of 2.85. The clinical signs were dominated by rectorrhagia (99%) complicated by anemia in 116 cases requiring blood transfusion in 72 cases, followed by proctalgia (27.4%). Transit disorders were noted in 65 patients (31.2%). Indications for elastic ligation were symptomatic internal hemorrhoids Grade 3 (65.4%) and Grade 2 (34.6%). The average number of ligation sessions that achieved the therapeutic goal was 2.30 sessions [1 - 4]. The average number of rings per session was 3.1 rings [1 - 6]. Moderate to severe pain was reported by 20 patients (9.6%) mostly within 6 hours of ligation. Minimal rectorrhagia was reported in 33 cases (15.8%). There were no major complications who required a hospitalization. The success rate was 80.7% (n = 168). Surgery was performed in 31 patients (14.9%) and sclerosis in 7 patients (3.3%). Conclusion: The elastic ligation of internal hemorrhoids remains an effective and inexpensive technique when it comes to the treatment of symptomatic internal hemorrhoids of Grade 2 to 3. The results obtained in our study were very reassuring and motivating.

Interest of Sclerosing Injections in Hemorrhoidal Pathology: Experience of the Service of Hepato-Gastroenterology of Fez

Hemorrhoids are a clinical and anatomical subject that has not been completely investigated [1]. This benign condition is expressed by intermittent functional manifestations as rectorrhagies and prolapse. while the medical treatments seek to relieve symptoms, the instrumental ones are intended to reposition and hold the hemorrhoids in an anatomically correct position and to reduce their vascularity [1]. Indeed, sclerotherapy seems an effective and safe method in fact. Aim of the Study: To report the results of a moroccan series of patients treated with sclerosing injections, emphasizing short- and long-term efficacy as well as the rate of complications. Methods: This is a descriptive retrospective study of the 148 patients with symptomatic internal hemorrhoids who have been treated with sclerotherapy in the gastroenterology department of the university medical center of Fez over a period of 17 years [2001-2018]. Results: The average age of our patients is 47.1 years [19 - 86]. We notified a large male predominance with a sex ratio M/F 2.58. Rectorrhagies and prolapse were the most frequent reasons for consultation; they were respectively notified in 96% (n = 143) and 83% of patients (n = 123). Anemia was found in 45 cases (30.4%), of which 29 cases required transfusion. Proctologic examination found internal hemorrhoids grade 2 in 83% (n = 124) and grade 1 in 16.2% (n = 24) of patients. Initial success was found in 119 cases (80.4%) after an average of 2.25 sessions (1 - 4). Nine patients (8, 11%) had minor complications dominated by minimal rectorrhagies in 8 cases, resolved spontaneously. In 29 cases (19.5%), the sessions were interrupted following a failure of the technique in 12 cases (41.3%), in 11 cases after change of the stage of hemorrhoids of stage II to III, in 4 cases following the appearance of an anal fissure contraindicating the procedure, and in 2 cases due to severe pain post sclerosis. Among these 29 cases, 13 patients were referred for surgery, while in 16 patients we opted for an instrumental treatment by ligature. The initial evolution was specified with a average follow-up of 3 months (1 - 13 months). The recurrence rate was 22.3% (N: 33 cases) after an average follow-up of 9.5 months (1 - 48 months). In the long term (over one year) and in the short term, the recidivism rate was 6% (n = 9 cases) and 16.2% (n = 24) respectively. Among recurrent patients, the sclerosis protocol was repeated in 20 patients (60.6%) with a success rate of 85%; for the remaining 13 patients, we opted for elastic ligation in 4 patients, and for surgery in 6 patients, while 3 patients were lost to follow-up. Conclusion: Since the end of the XIX century, sclerosis has been an instrumental technique, simple, inexpensive, and effective for the treatment of symptomatic internal hemorrhoids of grades 1 and 2, allowing good results in the long run, with minimal risk of complications.

New Topical Treatment of Symptomatic Internal Haemorrhoids in a General Practice Setting

Introduction: Oral usage of flavonoid-based drugs can be successfully applied in the conservative treatment of internal haemorrhoids; however, its efficiency in a form of topical preparations has not been demonstrated yet. The aim of the present study was to determine the efficiency of ointment with propolis extract (containing minimally 115 mg/kg of flavonoid galangin) in relief and suppression of the symptomatic internal haemorrhoids grade 1 and 2 (bleeding, prolapse, pain, and itching).&#x0D; Methods: This prospective cohort epidemiological study that included 46 participants of both genders, mean age 53.6±14.3 years, was conducted in the general practice setting in Osijek, Croatia and lasted for three months. A specially designed questionnaire was used to collect demographic data and data concerning the haemorrhoid disease symptoms and to evaluate the intensity of the latter data according to the scale defined in the research protocol.&#x0D; Results: The study showed statistically significant improvements in the intensity of all the symptoms connected with the internal haemorrhoids grade 1 and 2 (p&lt;0.001) during the follow up period, as well as statistically significant differences in proportions of participants with and without of the each of the analysed symptoms before and after the therapy (p&lt;0.001). After three months of therapy with ointment containing propolis extract 82.7% patients (38/46) had none of the analysed symptoms.&#x0D; Conclusions: Ointment with propolis extract efficiently affected all the analysed symptoms of the haemorrhoid disease thus having a very significant place within the conservative treatment of haemorrhoids.

Polidocanol Foam Injected at High Doses with Intravenous Needle: The (Almost) Perfect Treatment of Symptomatic Internal Hemorrhoids

Background and Aims: Hemorrhoid disorders are common. This study aimed to assess the efficacy and safety of polidocanol foam injected at high doses with intravenous needle for the treatment of symptomatic internal hemorrhoids that prolapse or bleed. Methods: We evaluated 2,000 consecutive patients with prolapsed hemorrhoids (grades II/III/IV) recruited over 6 years. Foam injection was performed in one to four sessions with polidocanol 2%: 10 mL of the mixture (2 mL liquid plus air) or 20 mL (4 mL liquid plus air). The number of sessions and amount of foam injected depended on initial hemorrhoid size, compliance to receive foam, and clinical response. The mixture, prepared using a three-way tap connected to two 10/20-mL syringes, was injected immediately after preparation using an intravenous needle. The primary endpoint was self-reported satisfaction without major complications at 4 weeks. Results: Efficacy was very high, with 1,957 patients (98%) reporting satisfaction regarding blood loss control and prolapse reduction. The procedure was well tolerated: 1,838 patients (92%) presented mild/no pain. Objective reduction of prolapse volume was documented in 86% of reobserved cases. Complications were rare and usually minor: only 3 cases of clinically significant bleeding (0.15%), 2 of whom were on dual antiplatelet therapy plus oral anticoagulation, 2 cases of rectal abscess, 8 hemorrhoid thromboses, and 1 urinary retention requiring catheter (0.7% severe complications). Conclusions: Treatment of internal hemorrhoids with polidocanol foam injected in high doses is very effective and safe for the control of blood loss and prolapse, even for patients on anticoagulation/antiplatelet treatment.

Clopidogrel bisulfate (Plavix) does not increase bleeding complications in patients undergoing rubber band ligation for symptomatic hemorrhoids

BackgroundThe incidence of postprocedural bleeding in patients undergoing rubber band ligation (RBL) for symptomatic internal hemorrhoids while taking clopidogrel bisulfate is unknown. To determine the postprocedural bleeding risk of RBL for patients taking clopidogrel compared with age- and sex-matched controls. Materials and methodsThis is a retrospective case-controlled cohort study analyzing data from 2005 to 2013 conducted at a single tertiary care academic center. The study included a total of 80 rubber bands placed on 41 patients taking clopidogrel bisulfate and 72 bands placed on 41 control patients not taking clopidogrel matched for age and sex. The 30-d rates of significant and insignificant bleeding events after RBL were recorded. A bleeding event was considered significant if the patient required admission to the hospital, transfusion of blood products, or additional procedures to stop the bleeding. Insignificant bleeding was defined as passage of blood or clots per rectum with spontaneous cessation and no need for additional intervention. ResultsThere was no significant difference in the number of bleeding events per band placed in the clopidogrel group when compared with the control group (3.75% versus 2.78%, P = 0.7387). The rate of significant (2.5% versus 1.39%, P = 0.6244) and insignificant bleeding events (1.25% versus 1.39%, P = 0.9399) was also similar between the two groups. Two significant bleeding events occurred in the clopidogrel group requiring intervention: cauterization in one patient and colonoscopy and transfusion in the other. ConclusionsThe risk of a bleeding complication after RBL for hemorrhoids does not appear to be increased in patients taking clopidogrel. Our results support the practice of continuing clopidogrel bisulfate in the periprocedural period as the associated risk of thrombosis is greater than the risk of bleeding.

Prospective, Multicenter Randomized Controlled Trial Comparing Two Hemorrhoidopexy Staplers: The HEMOSTASIS Study

The objective of this study was to compare two hemorrhoidopexy staplers (EEA versus PPH03). Stapled hemorrhoidopexy is a treatment option for patients with symptomatic internal hemorrhoids who have failed more conservative measures. However, staple line bleeding remains common. Recent improvements in stapler design have attempted to reduce intraoperative bleeding and the need for intervention. HEMOSTASIS is a prospective, multicenter, 1:1 randomized controlled trial. Twelve hospital centers in the United States enrolled participants between 18 and 85 years of age with symptomatic grades 2 to 3 internal hemorrhoids. The primary end point was intraoperative bleeding, defined as bleeding requiring intervention (e.g., placement of sutures, cauterization, or ligation to achieve hemostasis). Secondary end points included staple line location, postoperative pain, quality of life, operative time, length of hospital stay, adverse events, and complication rates. On the primary end point, the rates of intraoperative bleeding requiring intervention were 41.0% (32 of 78) with EEA and 70.4% (50 of 71) with PPH (P &amp;lt; 0.001). Treatment for active bleeding was required in 30.8% versus 57.7% (P &amp;lt; 0.001) in the EEA and PPH arms, respectively. There were no significant differences between groups in postoperative pain. Adverse events and perioperative complication rates were generally mild/moderate and were similar between groups: 74.1% (60 of 81) of patients in the EEA group reported at least one adverse event versus 80.9% (55 of 68) in the PPH group (P = 0.32). Intraoperative bleeding occurred less often after stapled hemorrhoidopexy with the EEA stapler compared with the PPH03 stapler. Intervention to achieve hemostasis was required less often with the EEA stapler.

New topical treatment of symptomatic internal hemorrhoids in a general practice setting

New topical treatment of symptomatic internal hemorrhoids in a general practice setting