1
|
Prevalent Technique and Results of Hemorrhoidal Embolization. J Clin Med 2022; 11:jcm11226631. [PMID: 36431108 PMCID: PMC9698593 DOI: 10.3390/jcm11226631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/01/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022] Open
Abstract
Hemorrhoids are blood cushions located in the anus and lower rectum, acknowledged as a common cause of bleeding, which can reduce quality of life. The development of minimally invasive techniques such as endovascular embolization of superior rectal artery, "Emborrhoid technique", is an effective treatment, with no pain or ischemic complications, and allows quick patient recovery. Our purpose is to describe the general technique and discuss the results of the current literature.
Collapse
|
2
|
Safety and Effectiveness of a New Electrical Detachable Microcoil for Embolization of Hemorrhoidal Disease, November 2020–December 2021: Results of a Prospective Study. J Clin Med 2022; 11:jcm11113049. [PMID: 35683436 PMCID: PMC9181639 DOI: 10.3390/jcm11113049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/05/2022] [Accepted: 05/23/2022] [Indexed: 12/26/2022] Open
Abstract
Purpose: The purpose of this study was to prospectively evaluate the efficacy and safety of a new, bare platinum, detachable microcoil as a metallic embolization agent in the treatment of hemorrhoidal disease. Material and Methods: This prospective single-center study evaluated a new, bare platinum, electrical, detachable microcoil (Prestige plus coil (Balt Montmorency France)) for use in vascular embolization in patients with hemorrhoidal disease. Between January 2020 and January 2021, 24 embolization procedures were performed in 21 patients (12 males, 9 females; mean age 44.3 ± 7.3). The inclusion criteria were: (a) participants with grade I, II and III hemorrhoidal disease on the Goligher classification; (b) patients older than 18 years of age with a score of greater than 4 on the French bleeding score (FBS) scale; (c) patients with scores greater than 2 on the scale of discomfort proposed by Tradi and Farfallah. (d) patients who underwent treatment that included the use of the new novel coil (Prestige plus coil (Balt)) as an embolic material. The exclusion criteria were participants who failed to provide informed consent and participants diagnosed with rectal bleeding due to other causes (cancer, fissures or others). Participants with severe renal insufficiency, non-correctable coagulation abnormalities and adverse reactions to the contrast medium not correctable with medication were also excluded. The symptoms, technical aspects, the transarterial approach, clinical and technical success complications and short-term outcomes were assessed. Results: Technical success was obtained in 100% of the cases. Seventeen (80.9%) patients experienced improvements in their hemorrhoidal disease. The VAS and QL scores improved by 4 and 1.5 points (81.2% and 87.5%), respectively, after embolization (pV: 0001). Three (14.2%) patients underwent a second embolization due to rebleeding. One patient (4.7%) underwent surgery. No major complications were observed. Three patients had minor complications. The assessment of subjective post-treatment symptoms and QL surveys showed significant differences from the baseline survey. Likewise, the measurement of the degree of satisfaction using a telephone survey at 12 months revealed a high degree of patient satisfaction over 10 points (mean 8.3 ± 1.1). Conclusions: The present study demonstrates that the use of the new, platinum, detachable, electrical microcoil is safe and well-tolerated in the treatment of hemorrhoidal disease. Key points: Catheter-directed hemorrhoidal dearterialization (CDHD) is the procedure of embolization with embolic agents for the treatment of internal hemorrhoids. CDHD is a simple and safe procedure that is accepted by patients and preserves the anal sphincter; it presents few complications when metal devices or microspheres are used as embolic agents. As the recommended embolization agent in treatments, the Prestige electrical, detachable coil is a safe, easy-to-use and effective arterial embolic device.
Collapse
|
3
|
Nguyenhuy M, Xu Y, Kok HK, Maingard J, Joglekar S, Jhamb A, Brooks M, Asadi H. Clinical Outcomes Following Rectal Artery Embolisation for the Treatment of Internal Haemorrhoids: A Systematic Review and Meta-Analysis. Cardiovasc Intervent Radiol 2022; 45:1351-1361. [PMID: 35551442 DOI: 10.1007/s00270-022-03154-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 04/09/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Haemorrhoidal disease (HD) is a common anorectal disorder which can substantially impair quality of life. Rectal artery embolisation (RAE) is a recently described technique for the management of HD, however, its clinical efficacy and safety are unclear at present. The objective of this systematic review and meta-analysis is to evaluate the clinical outcomes following RAE. METHODS The PubMed, MEDLINE and EMBASE databases were searched for studies specifying the management of haemorrhoids with RAE from January 2000 to October 2021. Primary outcomes were: French bleeding score (FBS), Visual analogue scale (VAS) for pain, general quality of life (QoL) score, and the Goligher prolapse score (GPS). Secondary outcomes were technical success, clinical success, postoperative complications, and technical outcomes. A random-effects meta-analysis was conducted. Study heterogeneity was evaluated, and sensitivity analysis was performed. RESULTS Thirteen eligible studies were identified including 381 patients. Rectal artery embolisation was associated with improvements in the FBS (mean difference [MD] 2.66; 95% confidence interval [CI] 2.10-3.23), VAS (MD 1.92; 95% CI 1.58-2.27) and QoL (MD 1.41; 95% CI 1.20-3.80), although the grade of internal haemerrhoids increased with uncertain clinical significance (MD 0.30; 95% CI 0.23-0.36). Technical success was achieved in almost all procedures (99%; 95% CI 94-100%) however clinical efficacy was lower (82%; 95% CI 73-89%). Procedural duration and radiation exposure were heterogeneous. No major complications occurred. CONCLUSION RAE demonstrates early clinical efficacy with low rates of peri-procedural complications or morbidity. RAE is a promising addition to the treatment options available for HD and warrants ongoing research.
Collapse
Affiliation(s)
| | - Yifan Xu
- Peninsula Health, Frankston, VIC, 3199, Australia
| | - Hong Kuan Kok
- Interventional Radiology Service, Northern Health Radiology, Epping, VIC, 3076, Australia
| | - Julian Maingard
- Department of Interventional Radiology, Monash Health, Clayton, VIC, 3168, Australia
| | - Shantanu Joglekar
- Department of General Surgery, Eastern Health, Box Hill, VIC, 3128, Australia
| | - Ashu Jhamb
- Department of Interventional Radiology, St Vincent's Melbourne, Fitzroy, VIC, 3065, Australia
| | - Mark Brooks
- Department of Interventional Radiology, Austin Health, Heidelberg, VIC, Australia
| | - Hamed Asadi
- Department of Interventional Radiology, Monash Health, Clayton, VIC, 3168, Australia
- Department of Interventional Radiology, Austin Health, Heidelberg, VIC, Australia
| |
Collapse
|
4
|
Talaie R, Torkian P, Moghadam AD, Tradi F, Vidal V, Sapoval M, Golzarian J. Hemorrhoid embolization: A review of current evidences. Diagn Interv Imaging 2021; 103:3-11. [PMID: 34456172 DOI: 10.1016/j.diii.2021.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/04/2021] [Accepted: 07/07/2021] [Indexed: 12/21/2022]
Abstract
Hemorrhoids are local vascular structure dilations in the lower rectum, associated with morbidity and reduced quality of life. Endovascular coil or particle embolization of the superior rectal arteries, known as Emborrhoid technique, is a minimally invasive, image-guided therapy that targets the hemorrhoidal plexus and reduces hemorrhage. The purpose of this review was to analyze the results of published studies to determine the efficacy, clinical outcomes, and morbidities associated with the endovascular occlusion of hemorrhoidal arteries for the treatment of internal hemorrhoids. Current evidences suggest that hemorrhoids treated by Emborrhoid technique using microcoils, embolic particles or a combination is safe with no reported serious complications. Hemorrhoid embolization can preserve the anal tone without direct anorectal trauma and maintain the hemorrhoidal tissue in place requiring minimal local wound care on an outpatient basis. However, due to the paucity of high-quality trials, further research is warranted to evaluate its long-term outcomes, compare its efficacy with other treatment modalities, and fully assess its role in the treatment of hemorrhoid.
Collapse
Affiliation(s)
- Reza Talaie
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, 55455 Minneapolis, USA.
| | - Pooya Torkian
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, 55455 Minneapolis, USA
| | - Arash Dooghaie Moghadam
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, 69120 Heidelberg, Germany
| | - Farouk Tradi
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone, AP-HM, 13005 Marseille, France
| | - Vincent Vidal
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone, AP-HM, 13005 Marseille, France
| | - Marc Sapoval
- Vascular and Oncological Interventional Radiology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France; Université de Paris, Faculté de Médecine, 75006 Paris, France
| | - Jafar Golzarian
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, 55455 Minneapolis, USA
| |
Collapse
|
5
|
Stecca T, Farneti F, Balestriero G, Barban M, Caratozzolo E, Zilio S, Massani M. Superior Rectal Artery Embolization for Symptomatic Grades 2 and 3 Hemorrhoidal Disease: 6-Month Follow-up among 43 Patients. J Vasc Interv Radiol 2021; 32:1348-1357. [PMID: 34166805 DOI: 10.1016/j.jvir.2021.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/21/2021] [Accepted: 06/14/2021] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To assess the technical and clinical success rates of superior rectal artery embolization in the treatment of symptomatic Grades 2 and 3 hemorrhoidal disease. MATERIALS AND METHODS Since March 2019, 43 patients (24 men and 19 women; mean age, 52 years [18-77 years]) with symptomatic hemorrhoidal disease have been treated and completed the 6-month follow-up with anamnestic questionnaire and disease scores, including French bleeding, Goligher prolapse, visual analog scale for pain, and quality of life. Clinical success was assessed at 7 days, 1 month, and 6 months of follow-up by updating the clinical scores. Statistical analysis was performed using SPSS 25.0. RESULTS In all, 25 patients had Grade 2 prolapse and 18 patients had Grade 3 prolapse, with 96% and 77%, respectively, having bleeding as a symptom. All patients were discharged within 24 hours. The reduction in the French bleeding score (global and single entity) in Grade 3 prolapse was statistically significant (P = .001). Improvement in the quality of life was significant in both groups (P < .05). No serious complications were registered. CONCLUSIONS Hemorrhoidal embolization was a safe and effective technique in the treatment of symptomatic hemorrhoidal disease with minimal hospitalization, pain, and disruption of daily activities. It can be offered to patients unwilling to undergo a surgical procedure but can also be indicated in the emergency setting for patients on anticoagulant therapy or those unfit for surgery.
Collapse
Affiliation(s)
- Tommaso Stecca
- UOC Prima Chirurgia, Dipartimento di Chirurgia, Azienda ULSS2 Marca Trevigiana, Treviso, Italy.
| | - Fabrizio Farneti
- Servizio di Radiologia Interventistica, Dipartimento di Radiologia, Azienda ULSS2 Marca Trevigiana, Treviso, Italy
| | - Giovanni Balestriero
- Servizio di Radiologia Interventistica, Dipartimento di Radiologia, Azienda ULSS2 Marca Trevigiana, Treviso, Italy
| | - Mario Barban
- UOC Prima Chirurgia, Dipartimento di Chirurgia, Azienda ULSS2 Marca Trevigiana, Treviso, Italy
| | - Ezio Caratozzolo
- UOC Prima Chirurgia, Dipartimento di Chirurgia, Azienda ULSS2 Marca Trevigiana, Treviso, Italy
| | - Silvia Zilio
- Dipartimento di Scienza Chirurgiche Oncologiche e Gastroenterologiche, Università di Padova, Padua, Italy
| | - Marco Massani
- UOC Prima Chirurgia, Dipartimento di Chirurgia, Azienda ULSS2 Marca Trevigiana, Treviso, Italy
| |
Collapse
|
6
|
Iezzi R, Campenni P, Posa A, Parello A, Rodolfino E, Marra AA, Ratto C, Manfredi R. Outpatient Transradial Emborrhoid Technique: A Pilot Study. Cardiovasc Intervent Radiol 2021; 44:1300-1306. [PMID: 33977328 DOI: 10.1007/s00270-021-02856-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To determine whether outpatient transradial emborrhoid technique can be performed safely and effectively in the treatment of symptomatic hemorrhoids. MATERIALS AND METHODS The transradial emborrhoid technique was used to treat 12 patients with symptomatic hemorrhoids in an outpatient setting during a 4-month period. After percutaneous catheterization of the left radial artery, a 5-Fr sheath was introduced to catheterize the inferior mesenteric artery and a microcatheter was advanced into the branches of the superior rectal artery for embolization with 0.018-inch detachable coils (Interlock and IDC-interlocking detachable coils). After embolization, the sheath was withdrawn and puncture site hemostasis was achieved using a wrist band. All patients were evaluated 6 h after the procedure to determine whether they meet the discharge criteria and were discharged the following day. The results of the emborrhoid treatment were assessed at the 4-week follow-up. RESULTS The emborrhoid technique was successful in all patients. There was no major complication associated with the procedure. All patients met the discharge criteria 6 h after the procedure. Reduction of local edema and of hemorrhoidal congestion was observed in all patients. At the follow-up visit, the mean Rorvik score (HDSS + SHS-HD) decreased from 31.50 (7.50) to 13.11 (8.33) (p < .001). CONCLUSIONS Transradial rectal artery embolization is a safe and effective treatment option for patients with chronic symptoms of hemorrhoid disease.
Collapse
Affiliation(s)
- Roberto Iezzi
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia - Istituto Di Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A Gemelli 8, 00168, Rome, Italy. .,Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Paola Campenni
- Proctology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A Gemelli 8, 00168, Rome, Italy
| | - Alessandro Posa
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia - Istituto Di Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A Gemelli 8, 00168, Rome, Italy
| | - Angelo Parello
- Proctology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A Gemelli 8, 00168, Rome, Italy
| | - Elena Rodolfino
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia - Istituto Di Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A Gemelli 8, 00168, Rome, Italy
| | - Angelo Alessandro Marra
- Proctology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A Gemelli 8, 00168, Rome, Italy
| | - Carlo Ratto
- Università Cattolica del Sacro Cuore, Rome, Italy.,Proctology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A Gemelli 8, 00168, Rome, Italy
| | - Riccardo Manfredi
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia - Istituto Di Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A Gemelli 8, 00168, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
7
|
Makris GC, Thulasidasan N, Malietzis G, Kontovounisios C, Saibudeen A, Uberoi R, Diamantopoulos A, Sapoval M, Vidal V. Catheter-Directed Hemorrhoidal Dearterialization Technique for the Management of Hemorrhoids: A Meta-Analysis of the Clinical Evidence. J Vasc Interv Radiol 2021; 32:1119-1127. [PMID: 33971251 DOI: 10.1016/j.jvir.2021.03.548] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/25/2021] [Accepted: 03/31/2021] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To assess the efficacy and safety of a catheter-directed hemorrhoidal dearterialization technique for the management of hemorrhoidal bleeding. MATERIALS AND METHODS A systematic review and meta-analysis of pubmed, cochrane, and scopus databases was conducted according to the preferred reporting items for systematic reviews and meta-Analysis (PRISMA) guidelines. Clinical studies reporting on catheter-directed hemorrhoidal dearterialization for rectal bleeding were analyzed. RESULTS Fourteen studies (n = 362) were identified. The mean maximum follow-up duration was 12.1 months (SD, 7.31; range, 1-28; median, 12), and the mean length of hospital stay was 1.5 days (SD, 1.1; range, 0-2.5). The mean technical success was 97.8% (SD, 3.5), and the mean clinical success was 78.9% (SD, 10.5). A statistically significant reduction in the french bleeding score before and after embolization was noted (P = .004). In subgroup analysis, when the coils-only group was compared with the coils and particles group, the average rebleeding rate was 21.5% (n = 111; SD, 18.2; range, 0%-44%) versus 10.05% (N = 108; SD, 4.8; range, 5%-15.7%), respectively (P < .0001). No bowel ischemia/necrosis or anorectal complications were reported. CONCLUSIONS The current preliminary clinical evidence suggests that catheter-directed hemorrhoidal dearterialization is an effective and safe procedure for the treatment of hemorrhoidal bleeding. The standardization of the technique and the generation of higher level evidence will be required to compare this minimally invasive procedure with more invasive surgical options for patients with grades I-III hemorrhoids and chronic bleeding.
Collapse
Affiliation(s)
- Gregory C Makris
- Vascular and Interventional Radiology Department, Guy's and St Thomas' Hospital, NHS Foundation Trust, London, United Kingdom; Clinical Imaging Department, Alfa Institute of Biomedical Sciences, Athens, Greece.
| | - Narayan Thulasidasan
- Vascular and Interventional Radiology Department, Guy's and St Thomas' Hospital, NHS Foundation Trust, London, United Kingdom
| | - George Malietzis
- Department of Surgery and Cancer, Imperial College of London, London, United Kingdom
| | | | - Affan Saibudeen
- Clinical Imaging Department, Medical School, University of Oxford, Oxford, United Kingdom
| | - Raman Uberoi
- Vascular and Interventional Radiology Department, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Athanasios Diamantopoulos
- Vascular and Interventional Radiology Department, Guy's and St Thomas' Hospital, NHS Foundation Trust, London, United Kingdom
| | - Marc Sapoval
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone, Marseille, France
| | - Vincent Vidal
- Vascular and Oncologic Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France
| |
Collapse
|