Clinical Outcomes Following Rectal Artery Embolisation for the Treatment of Internal Haemorrhoids: A Systematic Review and Meta-Analysis

Nguyenhuy, Minhtuan; Xu, Yifan; Kok, Hong Kuan; Maingard, Julian; Joglekar, Shantanu; Jhamb, Ashu; Brooks, Mark; Asadi, Hamed

doi:10.1007/s00270-022-03154-7

Cited by 5 publications

(5 citation statements)

References 39 publications

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“…Size reduction occurs within one month of treatment, with a quantifiable reduction in hemorrhoidal blood flow [31]. However, the degree of prolapse does not seem to change [31,36], with some publications finding a slight increase [42]. This is not unexpected given DGHAL and SCL add mucopexy when restoration of rectal mucosa is required [22].…”

Section: Outcomes and Safety In Current Literaturementioning

confidence: 99%

Prevalent Technique and Results of Hemorrhoidal Embolization

Gil

Puchol

Solaz

et al. 2022

JCM

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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.

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Section: Outcomes and Safety In Current Literaturementioning

confidence: 99%

Prevalent Technique and Results of Hemorrhoidal Embolization

Gil

Puchol

Solaz

et al. 2022

JCM

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“…Doppler-guided hemorrhoid artery ligation is performed via an anoscope with a Doppler probe that is used to localize hemorrhoidal artery branches for directed transanal suture ligation [ 8 ]. Building on the principles of hemorrhoidal dearterialization from doppler guided HAL, trans-arterial catheter-directed rectal artery embolization (RAE; “emborrhoid”) was first described by Vidal et al in 2014 as a treatment option for internal HD [ 9 , 10 ]. Over the next decade promising data have emerged on the technique, safety, and efficacy of rectal artery embolization for treatment of bleeding predominant IH [ 3 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…Over the next decade promising data have emerged on the technique, safety, and efficacy of rectal artery embolization for treatment of bleeding predominant IH [ 3 , 9 ]. Recent meta-analyses of clinical studies have shown high technical success (98–99%) and short-term clinical efficacy to 1-year (79–82%) with clinically significant improvements in bleeding scores, quality of life and pain scores reported [ 10 , 11 ]. Importantly, no bowel ischemia, necrosis or anorectal compilations have been reported [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…Recent meta-analyses of clinical studies have shown high technical success (98–99%) and short-term clinical efficacy to 1-year (79–82%) with clinically significant improvements in bleeding scores, quality of life and pain scores reported [ 10 , 11 ]. Importantly, no bowel ischemia, necrosis or anorectal compilations have been reported [ 10 , 11 ]. However, questions have remained regarding patient selection, the optimal embolization technique and method of outcome response assessment.…”

Section: Introductionmentioning

confidence: 99%

“…There is limited information available regarding standardized protocols, study designs, or data elements. Further research and clinical trials are necessary to establish these elements, evaluate the safety and efficacy of RAE, and compare it with other available treatment options for hemorrhoidal disease [ 1 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Common design and data elements on rectal artery embolization for treatment of symptomatic internal hemorrhoidal disease: an interactive systematic review of clinical trials

Morsi,

Linares Bolsegui,

Kobeissi

et al. 2024

CVIR Endovasc

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Background Internal hemorrhoids (IH) is a common medical condition that can result in morbidity secondary to bleeding and discomfort. Treatment for IH has traditionally consisted of dietary and conservative medical management, focal treatments including banding and sclerotherapy or hemorrhoidectomy. Recently, rectal artery embolization (RAE) has been studied as a potential treatment for bleeding predominant IH. We performed a common design and data element analysis of studies that report on RAE. Materials and methods We conducted a qualitative systematic literature review for rectal artery embolization (RAE) for symptomatic hemorrhoidal disease. The screening process involved five online databases (PubMed, Embase, Google Scholar, DOAJ, and Scopus). Additionally, ClinicalTrials.gov was examined for active, unpublished completed studies. The initial search yielded 2000 studies, with 15 studies meeting the inclusion criteria after screening and assessment. The included studies comprised one RCT, one case series, one pilot study and 12 cohort studies. Results The population analysis revealed a male predominance across all studies, with varying cohort sizes. The baseline Goligher hemorrhoid grade was utilized in 80% of studies. The majority (73.3%) employed a transfemoral approach, and coils were the primary embolic material in 60% of studies, 26.6% were combination of coils and particles, and 6.6% were particles only. Patient selection criteria highlighted RAE's applicability for high surgical risk patients and those with anemia, chronic hematochezia, or treatment-refractory cases. Exclusion criteria emphasized factors such as previous surgeries, colorectal cancer, rectal prolapse, acute hemorrhoidal complications, and contrast allergy. Study designs varied, with cohort studies being the most common (12/15; 80%). Procedural details included the use of metallic coils and detachable micro-coils, with a high technical success rate reported in most studies ranging from 72 to 100%. The follow-up ranged from 1 to 18 months. The majority of studies reported no major immediate or post-procedural complications. Conclusion While all studies focused on RAE as a treatment for IH, there was a great degree of heterogeneity among included studies, particularly regarding inclusion criteria, exclusion criteria, outcomes measures and timeframe. Future literature should attempt to standardize these design elements to help facilitate secondary analyses and increase understanding of RAE as a treatment option.

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