Search

Background: Sclerotherapy with 3% polidocanol foam is becoming increasingly popular for the treatment of symptomatic I–II or III degree haemorrhoidal disease (HD). However, there are no studies that have reported a follow‐up of more than 1 year. The purpose of this study was to analyse the long‐term outcomes of sclerotherapy with 3% polidocanol foam in the treatment of II–degree HD. Methods: This was an open label, single‐arm, phase 2b trial conducted in 10 tertiary referral centres for HD. A total of 183 patients with II–degree HD, aged between 18 and 75 years with symptomatic HD according to the Goligher classification and unresponsive to medical treatment, were included in the study and underwent sclerotherapy with 3% polidocanol foam. The efficacy was evaluated in terms of bleeding score, haemorrhoidal disease symptom score (HDSS) and short health scale for HD (SHS–HD) score. Successful treatment was defined as the complete absence of bleeding episodes after 7 days (T1) according to the bleeding score. Results: The overall success rate ranged from 95.6% (175/183) at 1 year to 90.2% (165/183) after the final 3 year follow‐up. The recurrence rate, based on the primary outcome, ranged from 12% (15/125) to 28% (35/125). The greatest increase in recurrence (15) was recorded between 12 and 18 months of follow‐up, then another five between 18 and 24 months. Both the HDSS and the SHS score remained statistically significant (p < 0.001) from a median preoperative value of 11 (10–13) and 18 (15–20) to 0 (0–2) and 4 (0–4), respectively. Symptom‐free (HDSS = 0) patients, excluding patients converted to surgery, increased from 55.5% (101/182) at 1 year to 65.1% at 3 years (110/169). There were no intraoperative complications in redo‐sclerotherapy nor additional adverse events (AEs) compared to the first 12 months. Conclusions: Sclerotherapy with 3% polidocanol foam is gradually establishing itself in the treatment of bleeding HD due to its repeatability, safety, convenience in terms of direct and indirect costs with the absence of discomfort for the patient as well as AEs rather than an excellent overall success rate. [ABSTRACT FROM AUTHOR]

Aim: Guidelines benefit patients and clinicians by distilling evidence into easy‐to‐read recommendations. The literature around the management of haemorrhoids is immense and guidelines are invaluable to improve treatment integrity and patient outcomes. We identified current haemorrhoid guidelines and assessed them for quality and consistency. Methods: A systematic search of the literature from January 2011 to October 2021 was carried out. Guidelines identified were assessed for quality using the AGREE II instrument and for consistency in terms of tabulated treatment recommendations. Results: During this period nine guidelines were identified worldwide. The general quality was poor with only one guideline considered of high enough quality for use. In general, expert selection criteria for guideline development groups were vaguely defined. There were inconsistencies in the interpretation of the published evidence leading to variation in treatment recommendations. Discussion: Fewer, higher quality guidelines, with more consistent results, are needed. Particular attention should be given to defining the selection of experts involved. [ABSTRACT FROM AUTHOR]

Aim: Anismus is a common cause of obstructed defaecation syndrome (ODS). The aim of the present review is to assess the efficacy and safety of puborectalis muscle (PRM) division in the treatment of anismus. Method: PubMed, Scopus, Web of Science and the Cochrane Library were searched for studies that assessed the outcome of PRM division in the treatment of anismus. The main outcome measures were subjective improvement in ODS, decrease in the Wexner constipation score and ODS score, and complications, namely faecal incontinence (FI). Results: Ten studies (204 patients, 63.7% male) were included. The weighted mean rate of initial subjective improvement across randomized trials was 97.6% (95% CI 94%–100%) and across nonrandomized studies it was 63.1 (95% CI 39.3%–87%). The weighted mean rate of 12‐month improvement across randomized trials was 64.9% (95% CI 53.3%–76.4%) and across nonrandomized studies it was 55.9% (95% CI 30.8%–81%). The weighted mean rate of FI across randomized trials was 12.1% (95% CI 4.2%–20%) and across nonrandomized studies it was 10.4% (95% CI 1.6%–19.3%). Male sex and unilateral PRM division were significantly associated with recurrence of symptoms after PRM division. Bilateral PRM division, posterior division, complete division and concomitant sphincterotomy were significantly associated with FI after PRM division. Conclusions: The use of PRM division for treatment of anismus was followed by some initial improvement in ODS symptoms which decreased to <60% 12 months after PRM division. The mean rate of FI after PRM division, namely 10%–12%, is a limitation of the technique. Further well‐designed trials are needed to verify the outcome of PRM division in the treatment of anismus. [ABSTRACT FROM AUTHOR]

GRAPH: Video S1 REFERENCES 1 Gallo G, Ronconi M, Trompetto M. Sclerotherapy with 3% polidocanol foam: revolutionizing outpatient treatment in patients with haemorrhoidal disease. 2019; 21 (2): 244 - 5. https://onlinelibrary.wiley.com/doi/10.1111/codi.14498 6 Skowronski A, Diaco E, Trompetto M, Gallo G. Use of video-guided sclerotherapy with 3% polidocanol foam for symptomatic second-degree haemorrhoidal disease - a video vignette. I Dear Editor i , Over the last few years, minimally invasive treatment of haemorrhoidal disease (HD) has been gaining popularity. [Extracted from the article]