Comparison of different embolic particles for superior rectal arterial embolization of chronic hemorrhoidal bleeding: gelfoam versus microparticle

Abstract

Background Whether 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. Methods Patients 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. Results A 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). Conclusions Both gelfoam particles and microparticles with comparable diameter in the endovascular treatment of hemorrhoidal bleeding demonstrated similarly good short-term efficacy and safety profile.

Arterial Embolization as a Prominent Option in the Treatment of Hemorrhoid Diseases

“…The various SRA embolizing agents used in the studies demonstrated similar clinical efficacy with satisfactory results, and no significant complications such as ischemic necrosis were observed [2,30]. Coils have the advantage of precisely controllable embolization at the bleeding site.…”

“…Transmural branches of the SRA play a crucial role in the arterial blood supply of the CCR. In this regard, many researchers have applied a series of endovascular treatments based on the vascular nature and anatomy of hemorrhoids [2,8,21,22,24,[27][28][29].…”

“…There is no guideline or consensus in the selection of embolic materials. This choice generally depends on the operator's preference in the current circumstances [2].…”

“…Current studies show that emborrhoid treatment may be an effective, safe and feasible alternative. However, current data are still insufficient to reach consensus on HD management [2,8,21,22,24,[27][28][29]. In the studies, success evaluation was generally made on technical and clinical basis.…”

“…Hemorrhoidal disease (HD) is the most common anorectal disease, with a reported prevalence of 4.4-39.0% depending on various variables [1,2]. The age group with the highest incidence is between the ages of 45-65 [3].…”