Catheter-directed hemorrhoidal embolization for rectal bleeding due to hemorrhoids (Goligher grade I-III): prospective outcomes from a Spanish emborrhoid registry.

Autor: De Gregorio MA; Interventional Radiology, Hospital Clínica Quiron, University of Zaragoza, Zaragoza, Spain., Guirola JA; GITMI, Hospital Clínico Universitario Lozano Blesa, University of Zaragoza, Zaragoza, Spain. joseandresguirola@gmail.com., Serrano-Casorran C; GITMI University of Zaragoza, Zaragoza, Spain., Urbano J; Interventional Radiology, Hospital Ramon y Cajal, GITMI, Madrid, Madrid, Spain., Gutiérrez C; Interventional Radiology, Hospital de Denia Marina Salud, Alicante, Spain., Gregorio A; Interventional Radiology, Hospital de Denia Marina Salud, Alicante, Spain., Sierre S; Interventional Radiology, Hospital Prof JP Garrahan, Buenos Aires, Argentina., Ciampi-Dopazo JJ; Interventional Radiology, Hospital Virgen de las Nieves, Granada, Spain., Bernal R; GITMI, Interventional Radiology, Hospital Clínica Quiron, Zaragoza, Spain., Gil I; Department of Surgery, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain., De Blas I; Epidemiology, University of Zaragoza, Zaragoza, Spain., Sánchez-Ballestín M; GITMI, Hospital Clínico Universitario Lozano Blesa, University of Zaragoza, Zaragoza, Spain., Millera A; Department of Surgery, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain.
Jazyk: angličtina
Zdroj: European radiology [Eur Radiol] 2023 Dec; Vol. 33 (12), pp. 8754-8763. Date of Electronic Publication: 2023 Jul 17.
DOI: 10.1007/s00330-023-09923-3
Abstrakt: Objectives: To evaluate the safety and efficacy of catheter-directed hemorrhoidal embolization (CDHE) by microcoil embolization for rectal bleeding due to hemorrhoids classified as Goligher grade I-III.
Methods: Eighty patients (62.5% males) with a mean age of 48 ± 9 years were recruited prospectively. All patients had symptomatic bleeding hemorrhoids. All patients were classified according to Goligher classification: grade I (13.7%), grade II (71.1%), grade III (15%), and no grade IV were recruited in this study. In all cases, microcoils were used to embolize the superior rectal artery(SRA), and microspheres if recurrence of bleeding occurred. Follow-up evaluation (1, 3, 6, and 12 months) included clinical examination and anoscopy. A questionnaire was conducted to determine improvement regarding bleeding, quality of life before, and the degree of patient satisfaction of each participant.
Results: Technical success was achieved in 100% of the cases. Fifty-five (68.7%) participants had the absence of rectal bleeding after 12 months of embolization. VAS and QL improved 4 points and 1.5 respectively after embolization. A total of 25/80 (31.3%) had a recurrence in rectal bleeding. Seventeen (21.3%) patients underwent a second embolization, and four patients (5%) were treated with open hemorrhoidectomy. No major complications were observed. Sixteen participants had minor complications. Subjective post-treatment symptom and QL surveys showed significant differences from the baseline survey. Likewise, the degree of satisfaction in the telephone survey at 12 months revealed a high degree of patient satisfaction (8.3±1.1).
Conclusions: The present study demonstrates that CDHE is a feasible, well-tolerated, ambulatory, anal sphincter-sparing procedure for the treatment of internal hemorrhoids.
Clinical Relevance Statement: CDHE is a simple procedure, well tolerated and accepted by patients, that preserves the anal sphincter and presents few complications when metal devices or microspheres are used as embolic agents.
Key Points: • The technical success rate of CDHE, defined as the closure of all the SRA in their distal segment, was achieved 100% of all patients. However, a second embolization treatment was required since 21.25% of the patients experienced rectal bleeding. • Overall, CDHE's safety profile is acceptable. After the procedure and 1 year of follow-up, no significant complications were observed. • Encouraging clinical outcomes have demonstrated CDHE in individuals with hemorrhoids and mild prolapse Goligher grades I-III with persistent rectal bleeding.
(© 2023. The Author(s), under exclusive licence to European Society of Radiology.)
Databáze: MEDLINE
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