Articles on Sclerotheraphy or Injection Therapy

Short-term and long-term results of combined sclerotherapy and rubber band ligation of hemorrhoids and mucosal prolapse.

Chew SS, Marshall L, Kalish L, Tham J, Grieve DA, Douglas PR, Newstead GL.

Colorectal Unit, Department of Surgery, Prince of Wales Hospital, Sydney, Australia.

Dis Colon Rectum. 2003 Sep; 46(9): 1232-7.

PURPOSE: Rubber band ligation is a common office procedure for symptomatic hemorrhoids. The aim of the study was to assess our short-term and long-term results of combined sclerotherapy and rubber band ligation in the management of hemorrhoids and incomplete mucosal prolapse. METHODS: Data on 6,739 patients who had previous combined sclerotherapy and rubber band ligation by the senior authors (GLN and PRD) were retrieved from the database dating between January 1976 and June 2000. These patients either had hemorrhoids or incomplete mucosal prolapse. Furthermore, questionnaires were sent to a random sample of 2,400 patients. Telephone interviews were performed for 600 of the nonrespondents. RESULTS: Of 6,739 patients (3,683 males; mean age, 46.7 years) in the database, 4,686 (70 percent) received the procedure once, and 2,053 (30 percent) received the procedure more than once. There were 5,689 patients (84 percent) who had their procedures performed consecutively within a planned period, and only 1,050 patients (16 percent) had repeat procedures after a period of more than 12 months from their last treatments. Thus, the recurrence rate was 16 percent. The overall complication rate was 3.1 percent, with minor bleeding being the major complaint. With regard to the questionnaire, 44 percent responded. The mean follow-up period was 6.5 (range, 1-11) years. There were patients who had residual symptoms of bleeding (19 percent), itch (21 percent), and lump (20 percent). However, 58 percent of patients who replied were asymptomatic. With satisfaction scores ranging from +3 to -3 (+3 indicating complete satisfaction and -3 indicating complete dissatisfaction), 90 percent scored >/=1, 9 percent scored 0 or less, and 1 percent did not specify a score. Hemorrhoidectomy was required in 7.7 percent of the responders. Of 600 phone interviews with the nonrespondents, 152 responded to the questionnaires. Although there was less satisfaction from the phone respondents, which may have accounted for the initial nonresponse, no statistical difference was detected in residual symptoms. CONCLUSIONS: Combined triple sclerotherapy and rubber band ligation is an effective treatment for early hemorrhoids and incomplete mucosal prolapse, with low rates of recurrence, complications, and hemorrhoidectomy, and it can be repeated easily.

A prospective randomized trial of consultant-led injection sclerotherapy compared with nurse practitioner-led noninvasive interventions in the management of patients with first and second degree haemorrhoids.

Porrett TR, Lunniss PJ.

Surgical Nurse Specialist Department, Homerton Hospital, London, UK.Thersa.porrett@homerton-hospital.thenhs.com

Colorectal Dis. 2001 Jul; 3(4): 227-31.

OBJECTIVE: To determine whether nurse practitioner (NP)-led advice in relation to bowel and defecatory habits in hemorrhoidal disease is as effective as local invasive treatment (sclerotherapy) in the management of patients with symptomatic 1st and 2nd degree haemorrhoids, with respect to both alleviation of presenting symptoms and relapse rate, and patients' understanding of their condition. PATIENTS AND METHODS: In a prospective randomized trial, 25 patients with bleeding haemorrhoids were allocated to receive either standard medical injection sclerotherapy (Group 1, n=13) or NP-led advice, information and bowel habit retraining (Group 2, n=12). Bulking agents were offered, when deemed appropriate, to patients in both groups. Treatment was administered by two clinicians only. Patients were assessed at 8 weeks, 4 months and finally at 6 months post treatment and any symptoms present were graded. RESULTS: At 6 months, symptomatic improvement was similar in both groups (mean range 3 points) with a patient expected to get better with a good degree of confidence (C.I: 2-4 points). However those patients in Group 2 would be expected to have a slightly better minimum level of improvement (GP 1 P=0.004 GP 2 P=0.0005). At six months, there was no statistical difference between the two groups with regard to the patient's perception of the amount of information given, the clarity of the explanation, and the ability of the patient to understand and discuss their problem. In relation to understanding the cause of their problem patients in Group 2 felt they had a higher level of understanding of the cause of their problem (U=13, NA=7, NB=10, P=0.05) and felt more able to prevent their problem returning (U=12, NA=7, NB=10, P=0.05). CONCLUSION: A bulking agent and Nurse led education, advice and bowel habit retraining is as effective in reducing the incidence of bleeding from 1st and 2nd degree haemorrhoids as injection sclerotherapy. Patients who consult a NP with symptomatic 1st and 2nd degree haemorrhoids feel more empowered in the long term. Non-invasive bowel retraining methods should be offered as an alternative to more traditional, invasive treatments for patients with symptomatic early hemorrhoidal disease.

A comparison of the simultaneous application of sclerotherapy and rubber band ligation, with sclerotherapy and rubber band ligation applied separately, for the treatment of haemorrhoids: a prospective randomized trial.

Kanellos I, Goulimaris I, Christoforidis E, Kelpis T, Betsis D.

4th Department of Surgery, Aristotle University of Thessaloniki, Antheon 1, GR 55236, Panorama, Thessaloniki, Greece. ik@hol.gr

Colorectal Dis. 2003 Mar; 5(2): 133-8.

OBJECTIVE: To compare simultaneous application of sclerotherapy and rubber band ligation, with sclerotherapy and rubber band ligation applied separately for the treatment of 2nd degree haemorrhoids. PATIENTS AND METHODS: Between 1993 and 1996, 255 patients that suffered from 2nd degree haemorrhoids were divided into 3 groups of 85 patients, each to receive either simultaneous sclerotherapy for smaller and rubber band ligation for larger piles (SCL/RBL) in one session, or sclerotherapy (SCL), or rubber band ligation (RBL), respectively. After a period of 4 years all patients were examined and their symptoms were recorded. RESULTS: The patients of the SCL group developed significantly fewer complications after treatment compared to the other two methods (P < 0.001), which did not differ from each other. After the SCL/RBL treatment, significantly more patients were symptom free (46%) than after SCL (8%), P < 0.001. There was no significant difference between the SCL/RBL (46%) and the RBL (31%) groups (P = 0.217), although the combined treatment seemed to be more effective than rubber band ligation. Only 10% of the patients of the SCL/RBL group needed additional sessions 6-24 months after the initial treatment compared to 30% of the patients of the SCL group (P = 0.001). However, there was no significant difference between SCL/RBL and RBL (17%) groups (P = 0.151). CONCLUSION: The combination of sclerotherapy and rubber band ligation for treatment of 2nd degree haemorrhoids is significantly more efficient than sclerotherapy on its own.

Long-term evaluation of sclerotherapy for haemorrhoids. A prospective study.

Kanellos I, Goulimaris I, Vakalis I, Dadoukis I.

4th Department of Surgery, Aristotle University of Thessaloniki, Greece.

Int J Surg Investig. 2000; 2(4): 295-8.

BACKGROUND: Sclerotherapy is one of the older methods of conservative treatment of haemorrhoids. It has been widely used and the early results are considered satisfactory although the long-term results are not as good as expected. AIMS: The evaluation of long-term results of sclerotherapy in patients with symptomatic 1st and 2nd degree haemorrhoids. METHODS: From 1990 until 1996, 240 outpatients, 154 men and 86 women, with symptomatic 1st and 2nd degree haemorrhoids, underwent sclerotherapy. The most common symptoms were bleeding for patients with 1st degree haemorrhoids and prolapse for patients with 2nd degree. After 3 years all patients were called and examined and their symptoms were recorded. 38 patients were excluded. RESULTS: 3 years after sclerotherapy 20 patients (20.2%) with 1st degree haemorrhoids and 9 patients (8.7%) with 2nd degree were symptoms free. 42 patients (42.4%) with 1st degree haemorrhoids and 66 patients (64.1%) with 2nd degree were worse, and the remainder were either improved or unchanged. Bleeding and prolapse were the most frequent recurrent symptoms. CONCLUSION: The frequency of recurrent symptoms 3 years after sclerotherapy for symptomatic 1st and 2nd degree haemorrhoids is high. Sclerotherapy appears to be an inappropriate method of treatment for symptomatic 1st and especially 2nd degree haemorrhoids.