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

Abstract

BACKGROUND 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. AIM To assess long-term efficacy and safety of cap-assisted endoscopic sclerotherapy (CAES) with long injection needle for internal hemorrhoids. METHODS 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. RESULTS 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. CONCLUSION 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.

Sclerotherapy for hemorrhoidal disease: systematic review and meta-analysis

“…Only eight studies described endoscopic administration [ 29 , 31 , 39 , 40 , 46 , 54 – 56 ], while anoscopy was the adopted route in the remaining studies. The most frequently injected agent was polidocanol ( n = 17 [39%] studies) in different states (liquid or foam; Table 1 ) and at different concentrations (1–3%), followed by 5% phenol oil ( n = 15 [34%] studies).…”

Endoscopic approaches to the management of hemorrhoids

“…Xie et al [18 ▪▪ ] in 2022, in a single-center retrospective cohort study comprising 201 patients, sought to assess long-term efficacy and safety of CAES with long injection needle for internal hemorrhoids grades I–IV. This is the largest reported sample size in the treatment of hemorrhoids with CAES and long needles.…”