Prospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2024; 30(17): 2332-2342
Published online May 7, 2024. doi: 10.3748/wjg.v30.i17.2332
Transanal eco-Doppler evaluation after hemorrhoidal artery embolization
Roberta Tutino, Tommaso Stecca, Fabrizio Farneti, Marco Massani, Giulio Aniello Santoro
Roberta Tutino, Dipartimento Chirurgia Generale e Specialistica, AOU Città della Salute e della Scienza di Torino, Torino 10126, Italy
Roberta Tutino, Tommaso Stecca, Marco Massani, Division of General Surgery 1, Treviso Regional Hospital, AULSS 2 Marca Trevigiana, Treviso 31100, Italy
Fabrizio Farneti, Division of Radiology, Treviso Regional Hospital, AULSS 2 Marca Trevigiana, Treviso 31100, Italy
Giulio Aniello Santoro, Tertiary Referral Pelvic Floor Center, Division of General Surgery 2, AULSS 2 Marca Trevigiana, Treviso 31100, Italy
Author contributions: Massani M and Santoro GA contributed equally to this paper; Tutino R and Santoro GA made substantial contributions to conception and design, data acquisition, data analysis and interpretation; Stecca T and Farneti F made substantial contributions to data acquisition; Massani M made substantial contributions to data analysis and interpretation; Tutino R and Santoro GA drafted the article and revised it critically for important intellectual content; Stecca T, Farneti F, and Massani M also revised it critically for important intellectual content; All the authors provided final approval of the version to be published.
Institutional review board statement: The study was reviewed and approved by the AULSS2 Institutional Review Board (Approval No. 1286/CE Marca).
Clinical trial registration statement: This study is registered at clinicaltrials.gov. The registration identification number is NCT05627999.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors of this manuscript declare that they have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Roberta Tutino, MD, PhD, Doctor, Surgeon, Dipartimento Chirurgia Generale e Specialistica, AOU Città della Salute e della Scienza di Torino, 88 Corso Bramante, Torino 10126, Italy. la.tutino@gmail.com
Received: January 3, 2024
Peer-review started: January 3, 2024
First decision: January 16, 2024
Revised: February 13, 2024
Accepted: March 27, 2024
Article in press: March 27, 2024
Published online: May 7, 2024
Processing time: 122 Days and 17.3 Hours
Abstract
BACKGROUND

Hemorrhoidal artery embolization (Emborrhoid) is a novel method for the treatment of severe hemorrhoidal bleeding. Despite having a technical success rate of 93%-100%, the clinical success ranges between 63% and 94%, with a rebleeding rate of 13.6%.

AIM

To evaluate the effectiveness of this procedure in reducing hemorrhoidal flow and hemorrhoidal bleeding.

METHODS

This prospective observational pilot study was conducted at Division of General Surgery 1 and Tertiary Referral Pelvic Floor Center, Treviso Regional Hospital, Italy. In a 2 months period (February-March 2022), consecutive patients with hemorrhoidal bleeding scores (HBSs) ≥ 4, Goligher scores of II or III, failure of non-operative management, and a candidate for Emborrhoid were included. Endoanal ultrasound with eco-Doppler was performed preoperatively and 1 month after the procedure. The primary endpoint was to quantify the changes in arterial hemorrhoidal flow after treatment. The secondary endpoint was to evaluate the correlation between the flow changes and the HBS.

RESULTS

Eleven patients underwent Emborrhoid. The overall pretreatment mean systolic peak (MSP) was 14.66 cm/s. The highest MSP values were found in the anterior left lateral (17.82 cm/s at 1 o’clock and 15.88 cm/s at 3 o’clock) and in the posterior right lateral (14.62 cm/s at 7 o’clock and 16.71 cm/s at 9 o’clock) quadrants of the anal canal. After treatment, the overall MSP values were significantly reduced (P = 0.008) although the correlation between MSP and HBS changes was weak (P = 0.570). A statistical difference was found between distal embolization compared with proximal embolization (P = 0.047). However, the coil landing zone was not related to symptoms improvement (P = 1.000). A significant difference in MSP changes was also reported between patients with type 1 and type 2 superior rectal artery (SRA) anatomy (P = 0.040). No relationship between hemorrhoidal grades (P = 1.000), SRA anatomy (P = 1.000) and treatment outcomes was found.

CONCLUSION

The preliminary findings of this pilot study confirm that Emborrhoid was effective in reducing the arterial hemorrhoidal flow in hemorrhoidal disease. However, the correlation between the post-operative MSP and HBS changes was weak. Hemorrhoidal grade, SRA anatomy and type of embolization were not related to treatment outcomes.

Keywords: Hemorrhoidal artery embolization, Hemorrhoidal embolization, Hemorrhoidal vascularization, Transanal eco-Doppler, Transanal ultrasound

Core Tip: This was a prospective observational pilot study seeking to evaluate the changes in the arterial hemorrhoidal flow after hemorrhoidal artery embolization, and the correlation between the mean systolic peak and the hemorrhoidal bleeding score changes. Embolization was effective in reducing the arterial hemorrhoidal flow in hemorrhoidal disease, however the correlation between flow and symptoms was weak.