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Original Article

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Polidocanol Foam Injected at High Doses with Intravenous Needle: The (Almost) Perfect Treatment of Symptomatic Internal Hemorrhoids

Fernandes V.a,b · Fonseca J.c,d

Author affiliations

aClínica de Gastrenterologia de Almada, Almada, Portugal
bClínica CUF Almada, Monte da Caparica, Portugal
cHospital Garcia de Orta, Almada, Portugal
dCentro de Investigação Interdisciplinar Egas Moniz, Monte da Caparica, Portugal

Corresponding Author

Prof. Jorge Fonseca

Department of Gastroenterology, Hospital Garcia de Orta

Avenida Torrado da Silva

PT–2800 Almada (Portugal)

E-Mail jorgedafonseca@hotmail.com

Keywords: Polidocanol foamHemorrhoidsProlapseHematocheziaTreatment

Related Articles for ""
GE Port J Gastroenterol 2019;26:169–175
https://doi.org/10.1159/000492202

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Abstract

Background and Aims: Hemorrhoid disorders are common. This study aimed to assess the efficacy and safety of polidocanol foam injected at high doses with intravenous needle for the treatment of symptomatic internal hemorrhoids that prolapse or bleed. Methods: We evaluated 2,000 consecutive patients with prolapsed hemorrhoids (grades II/III/IV) recruited over 6 years. Foam injection was performed in one to four sessions with polidocanol 2%: 10 mL of the mixture (2 mL liquid plus air) or 20 mL (4 mL liquid plus air). The number of sessions and amount of foam injected depended on initial hemorrhoid size, compliance to receive foam, and clinical response. The mixture, prepared using a three-way tap connected to two 10/20-mL syringes, was injected immediately after preparation using an intravenous needle. The primary endpoint was self-reported satisfaction without major complications at 4 weeks. Results: Efficacy was very high, with 1,957 patients (98%) reporting satisfaction regarding blood loss control and prolapse reduction. The procedure was well tolerated: 1,838 patients (92%) presented mild/no pain. Objective reduction of prolapse volume was documented in 86% of reobserved cases. Complications were rare and usually minor: only 3 cases of clinically significant bleeding (0.15%), 2 of whom were on dual antiplatelet therapy plus oral anticoagulation, 2 cases of rectal abscess, 8 hemorrhoid thromboses, and 1 urinary retention requiring catheter (0.7% severe complications). Conclusions: Treatment of internal hemorrhoids with polidocanol foam injected in high doses is very effective and safe for the control of blood loss and prolapse, even for patients on anticoagulation/antiplatelet treatment.

© 2018 Sociedade Portuguesa de Gastrenterologia Published by S. Karger AG, Basel

Polidocanol espumoso em doses altas injetado com agulha endovenosa: O tratamento (quase) perfeito das hemorróidas internas sintomáticas

Palavras Chave

Polidocanol espumoso · Hemorróidas · Prolapso · Hematoquésia · Tratamento ·

Resumo

Introdução e objetivo: A doença hemorroidária é muito vulgar. O presente estudo pretende avaliar a eficácia e a segurança do polidocanol espumoso em doses altas injetado com agulha endovenosa no tratamento das he­morróidas internas que prolapsam e sangram. Métodos: Foram avaliados 2,000 doentes consecutivos, com he­morróidas prolapsadas (graus II/III/IV), ao longo de 6 anos. O polidocanol espumoso foi injetado em uma a quatro sessões: 10 ml de mistura (2 ml de polidocanol a 2% + ar) ou 20 ml de mistura (4 ml de polidocanol a 2% + ar). O número de sessões e a quantidade de espuma injetada dependeram do tamanho inicial das hemorróidas, da complacência durante a injeção e da resposta clínica. A mistura foi preparada usando uma torneira de três vias e duas seringas de 10/20 ml e injetada imediatamente após a preparação, usando uma agulha endovenosa. O objetivo primário foi a satisfação avaliada pelo doente, sem complicações graves, 4 semanas após o tratamento. Resultados: A eficácia foi muito elevada, com 1,957 doentes (98%) satisfeitos com a redução do prolapso e o controlo da hemorragia. O tratamento foi bem tolerado: 92% (1,838 doentes) não tiveram dor ou sofreram dor ligeira. A redução do prolapso foi documentada em 86% dos casos reobservados. As complicações foram raras e maioritariamente ligeiras: só 3 casos sofreram hemorragia significativa (0.15%), dois dos quais sob anticoagulação e dupla antiagregação; 2 casos de abcesso rectal; 8 tromboses hemorroidárias; e uma retenção urinária necessitando algaliação (complicações graves: 0.7%). Conclusões: O tratamento das hemorróidas internas com polidocanol espumoso injetado em dose elevada é eficaz, controlando a hemorragia e o prolapso, e seguro, mesmo em doentes sob anticoagulação/antiagregação.



Related Articles:

References

  1. Jacobs D: Clinical practice. Hemorrhoids. N Engl J Med 2014; 371: 944–951.
  2. Bleday R, Breen E: Home and office treatment of symptomatic hemorrhoids. UpToDate 2017. http://www.uptodate.com/contents/treatment-of-hemorrhoids.
  3. Rivadeneira DE, Steele SR, Ternent C, et al: Practice parameters for the management of hemorrhoids (revised 2010). Dis Colon Rectum 2011; 54: 1059–1064.
  4. Singer M: Hemorrhoids; in Beck DE, Robert PL, Saclarides TJ, et al (eds): The ASCRS Textbook of Colon and Rectal Surgery, ed 2. New York, Springer, 2011, pp 175–202.
  5. Schubert MC, Sridhar S, Schade RR, Wexner SD: What every gastroenterologist needs to know about common anorectal disorders. World J Gastroenterol 2009; 15: 3201–3209.
  6. Riss S, Weiser FA, Schwameis K, et al: The prevalence of hemorrhoids in adults. Int J Colorectal Dis 2012; 27: 215–220.
  7. Bleday R, Breen E: Hemorrhoids: clinical manifestations and diagnosis. UpToDate 2017. http://www.uptodate.com/contents/hemorrhoids-clinical-manifestations-and-diagnosis.
  8. Linares Santiago E, Gómez Parra M, Mendoza Olivares FJ, et al: Effectiveness of hemorrhoidal treatment by rubber band ligation and infrared photocoagulation. Rev Esp Enferm Dig 2001; 93: 238–247.
  9. MacRae HM, McLeod RS: Comparison of hemorrhoidal treatments: a meta-analysis. Can J Surg 1997; 40: 14–17.
  10. Rivadeneira DE, Steele SR: Surgical treatment of hemorrhoidal disease. UpToDate 2017. http://www.uptodate.com/contents/surgical-treatment-of-hemorrhoidal-disease.
  11. Sneider EB, Maykel JA: Diagnosis and management of symptomatic hemorrhoids. Surg Clin North Am 2010; 90: 17–32.
  12. Chand M, Nash GF, Dabbas N: The management of haemorrhoids. Br J Hosp Med (Lond) 2008; 69: 35–40.
  13. MacRae HM, McLeod RS: Comparison of hemorrhoidal treatment modalities. A meta-analysis. Dis Colon Rectum 1995; 38: 687–694.
  14. Lohsiriwat V: Treatment of hemorrhoids: a coloproctologist’s view. World J Gastroenterol 2015; 21: 9245–9252.
  15. Jayaraman S, Colquhoun PH, Malthaner RA: Stapled versus conventional surgery for hemorrhoids. Cochrane Database Syst Rev 2006; 4:CD005393.
  16. Watson AJ, Hudson J, Wood J, et al: Comparison of stapled haemorrhoidopexy with traditional excisional surgery for haemorrhoidal disease (eTHoS): a pragmatic, multicentre, randomised controlled trial. Lancet 2016; 388: 2375–2385.
  17. Giordano P, Gravante G, Sorge R, et al: Long-term outcomes of stapled hemorrhoidopexy vs conventional hemorrhoidectomy: a meta-analysis of randomized controlled trials. Arch Surg 2009; 144: 266–272.
  18. Moser KH, Mosch C, Walgenbach M, Bussen DG, Kirsch J, Joos AK, Gliem P, Sauerland S: Efficacy and safety of sclerotherapy with polidocanol foam in comparison with fluid sclerosant in the treatment of first-grade haemorrhoidal disease: a randomised, controlled, single-blind, multicentre trial. Int J Colorectal Dis 2013; 28: 1439–1447.
  19. Ouvry P, Allaert FA, Desnos P, et al: Efficacy of polidocanol foam versus liquid in sclerotherapy of the great saphenous vein: a multicenter randomized controlled trial with a 2-year follow-up. Eur J Vasc Endovasc Surg 2008; 36: 366–370.
  20. Johanson JF, Sonnenberg A: The prevalence of hemorrhoids and chronic constipation: an epidemiologic study. Gastroenterology 1990; 98: 380–386.

Article / Publication Details

First-Page Preview
Abstract of Original Article

Received: May 12, 2018
Accepted: July 16, 2018
Published online: August 31, 2018
Issue release date: May - June

Number of Print Pages: 7
Number of Figures: 3
Number of Tables: 1

ISSN: 2341-4545 (Print)
eISSN: 2387-1954 (Online)

For additional information: https://www.karger.com/PJG

References

  1. Jacobs D: Clinical practice. Hemorrhoids. N Engl J Med 2014; 371: 944–951.
  2. Bleday R, Breen E: Home and office treatment of symptomatic hemorrhoids. UpToDate 2017. http://www.uptodate.com/contents/treatment-of-hemorrhoids.
  3. Rivadeneira DE, Steele SR, Ternent C, et al: Practice parameters for the management of hemorrhoids (revised 2010). Dis Colon Rectum 2011; 54: 1059–1064.
  4. Singer M: Hemorrhoids; in Beck DE, Robert PL, Saclarides TJ, et al (eds): The ASCRS Textbook of Colon and Rectal Surgery, ed 2. New York, Springer, 2011, pp 175–202.
  5. Schubert MC, Sridhar S, Schade RR, Wexner SD: What every gastroenterologist needs to know about common anorectal disorders. World J Gastroenterol 2009; 15: 3201–3209.
  6. Riss S, Weiser FA, Schwameis K, et al: The prevalence of hemorrhoids in adults. Int J Colorectal Dis 2012; 27: 215–220.
  7. Bleday R, Breen E: Hemorrhoids: clinical manifestations and diagnosis. UpToDate 2017. http://www.uptodate.com/contents/hemorrhoids-clinical-manifestations-and-diagnosis.
  8. Linares Santiago E, Gómez Parra M, Mendoza Olivares FJ, et al: Effectiveness of hemorrhoidal treatment by rubber band ligation and infrared photocoagulation. Rev Esp Enferm Dig 2001; 93: 238–247.
  9. MacRae HM, McLeod RS: Comparison of hemorrhoidal treatments: a meta-analysis. Can J Surg 1997; 40: 14–17.
  10. Rivadeneira DE, Steele SR: Surgical treatment of hemorrhoidal disease. UpToDate 2017. http://www.uptodate.com/contents/surgical-treatment-of-hemorrhoidal-disease.
  11. Sneider EB, Maykel JA: Diagnosis and management of symptomatic hemorrhoids. Surg Clin North Am 2010; 90: 17–32.
  12. Chand M, Nash GF, Dabbas N: The management of haemorrhoids. Br J Hosp Med (Lond) 2008; 69: 35–40.
  13. MacRae HM, McLeod RS: Comparison of hemorrhoidal treatment modalities. A meta-analysis. Dis Colon Rectum 1995; 38: 687–694.
  14. Lohsiriwat V: Treatment of hemorrhoids: a coloproctologist’s view. World J Gastroenterol 2015; 21: 9245–9252.
  15. Jayaraman S, Colquhoun PH, Malthaner RA: Stapled versus conventional surgery for hemorrhoids. Cochrane Database Syst Rev 2006; 4:CD005393.
  16. Watson AJ, Hudson J, Wood J, et al: Comparison of stapled haemorrhoidopexy with traditional excisional surgery for haemorrhoidal disease (eTHoS): a pragmatic, multicentre, randomised controlled trial. Lancet 2016; 388: 2375–2385.
  17. Giordano P, Gravante G, Sorge R, et al: Long-term outcomes of stapled hemorrhoidopexy vs conventional hemorrhoidectomy: a meta-analysis of randomized controlled trials. Arch Surg 2009; 144: 266–272.
  18. Moser KH, Mosch C, Walgenbach M, Bussen DG, Kirsch J, Joos AK, Gliem P, Sauerland S: Efficacy and safety of sclerotherapy with polidocanol foam in comparison with fluid sclerosant in the treatment of first-grade haemorrhoidal disease: a randomised, controlled, single-blind, multicentre trial. Int J Colorectal Dis 2013; 28: 1439–1447.
  19. Ouvry P, Allaert FA, Desnos P, et al: Efficacy of polidocanol foam versus liquid in sclerotherapy of the great saphenous vein: a multicenter randomized controlled trial with a 2-year follow-up. Eur J Vasc Endovasc Surg 2008; 36: 366–370.
  20. Johanson JF, Sonnenberg A: The prevalence of hemorrhoids and chronic constipation: an epidemiologic study. Gastroenterology 1990; 98: 380–386.
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This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND). Usage and distribution for commercial purposes as well as any distribution of modified material requires written permission. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
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