“Long-term Efficacy of Hemorrhoid Artery Embolization in an Outpatient Multidisciplinary Center: A Review of 221 Patients” will be presented during the Closing Plenary Session on Wednesday, March 27, at 10:30 a.m. MT.
A new study shows that hemorrhoidal artery embolization is an effective, long-term outpatient treatment option for refractory symptomatic internal hemorrhoids.
“Going into this study, we looked at the available treatment options for treating hemorrhoids in their short-term efficacy,” said Sandeep Bagla, MD. “There are high failure rates with rubber band ligation, and while more invasive procedures such as surgery may offer patients a more durable treatment option, there’s higher risk.”
According to Dr. Bagla and Abin Sajan, MD, the lead author of “Long-term Efficacy of Hemorrhoid Artery Embolization in an Outpatient Multidisciplinary Center: A Review of 221 Patients,” their goal was to highlight the long-term success of hemorrhoidal artery embolization.
“If the data show safe and effective outcomes, we may be able to offer hemorrhoidal artery embolization as a more widespread treatment that doesn’t have the morbidity or pain associated with other treatments,” Dr. Bagla said.
Researchers reviewed data from 221 patients—115 males and 106 females—in an outpatient-based, multidisciplinary practice where interventional radiology practices alongside gastroenterology.
According to Dr. Bagla, researchers found that patients had significant improvements in their hemorrhoid-related symptoms, which included things like pain, quality of life and hemorrhoid prolapse (where hemorrhoids prolapse out of the anorectal junction). Their symptoms improved significantly overall, and they were durable out to 1 year, which is longer than previously reported studies, Dr. Bagla said. They also found that it is safe, with a very small number of minor complications that resolved on their own.
After undergoing embolization of the abnormal vascular blush at the hemorrhoidal cushion, patients were evaluated at baseline of 1, 3 and 6–12 months. Researchers looked at standardized outcomes, such as hemorrhoid-related pain, hemorrhoid symptoms score, quality of life, French bleeding score and Goligher’s hemorrhoid grade.
According to the researchers, technical success was achieved in 100% of patients; clinical success was seen in 90% of patients at 1-month post-procedural follow-up. Twenty-one patients required repeat embolization. Significant improvements were demonstrated for all measured outcomes at 1, 3 and 6–12 months.
“The procedure is very versatile, meaning you could do it on patients who might not be candidates for or don’t want the traditional therapies, or who have failed those therapies,” said Dr. Bagla. In addition, the data provided insight on why hemorrhoidal artery embolization may have failed in some patients. “Those patients likely only experienced short-term improvement because their middle rectal artery wasn’t embolized.” Dr. Bagla said “They can be subsequently treated again and expect a durable or effective outcome.”
In the 21 patients who failed the procedure, researchers went back and treated the middle rectal artery, and those patients also had significant improvement.
According to Dr. Sajan, the study and treatment of hemorrhoids requires working closely with other specialties. “It has to be a collaborative effort, especially with hemorrhoids where you have such a huge patient population,” he said, noting that all patients were assessed by a gastroenterologist before and after the procedure. “With any new procedure, and especially with a disease where the disease matter experts are in another specialty, it’s very important for anyone who’s considering getting involved in this research or utilizing the procedure clinically to keep in mind that a lot of research doesn’t necessarily translate to clinical practice unless you operate within that same framework,” Dr. Bagla said.
He added that although the data indicates that embolization is an effective treatment option, it can and should co-exist with rubber band ligation as a minimally invasive hemorrhoid therapy. “I don’t think that embolization should be seen as a replacement for rubber band ligation, but maybe perhaps as an augment,” Dr. Bagla said. “The reality is that there are so many patients suffering from hemorrhoids, so there is a large population that can be targeted for this procedure.”
