Gregory C Makris1, Narayan Thulasidasan2, George Malietzis3, Christos Kontovounisios3, Affan Saibudeen4, Raman Uberoi5, Athanasios Diamantopoulos2, Marc Sapoval6, Vincent Vidal7. 1. Vascular and Interventional Radiology Department, Guy's and St Thomas' Hospital, NHS Foundation Trust, London, United Kingdom; Clinical Imaging Department, Alfa Institute of Biomedical Sciences, Athens, Greece. Electronic address: g.makris09@doctors.org.uk. 2. Vascular and Interventional Radiology Department, Guy's and St Thomas' Hospital, NHS Foundation Trust, London, United Kingdom. 3. Department of Surgery and Cancer, Imperial College of London, London, United Kingdom. 4. Clinical Imaging Department, Medical School, University of Oxford, Oxford, United Kingdom. 5. Vascular and Interventional Radiology Department, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom. 6. Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone, Marseille, France. 7. Vascular and Oncologic Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France.
Abstract
PURPOSE: To assess the efficacy and safety of a catheter-directed hemorrhoidal dearterialization technique for the management of hemorrhoidal bleeding. MATERIALS AND METHODS: A systematic review and meta-analysis of pubmed, cochrane, and scopus databases was conducted according to the preferred reporting items for systematic reviews and meta-Analysis (PRISMA) guidelines. Clinical studies reporting on catheter-directed hemorrhoidal dearterialization for rectal bleeding were analyzed. RESULTS: Fourteen studies (n = 362) were identified. The mean maximum follow-up duration was 12.1 months (SD, 7.31; range, 1-28; median, 12), and the mean length of hospital stay was 1.5 days (SD, 1.1; range, 0-2.5). The mean technical success was 97.8% (SD, 3.5), and the mean clinical success was 78.9% (SD, 10.5). A statistically significant reduction in the french bleeding score before and after embolization was noted (P = .004). In subgroup analysis, when the coils-only group was compared with the coils and particles group, the average rebleeding rate was 21.5% (n = 111; SD, 18.2; range, 0%-44%) versus 10.05% (N = 108; SD, 4.8; range, 5%-15.7%), respectively (P < .0001). No bowel ischemia/necrosis or anorectal complications were reported. CONCLUSIONS: The current preliminary clinical evidence suggests that catheter-directed hemorrhoidal dearterialization is an effective and safe procedure for the treatment of hemorrhoidal bleeding. The standardization of the technique and the generation of higher level evidence will be required to compare this minimally invasive procedure with more invasive surgical options for patients with grades I-III hemorrhoids and chronic bleeding.
PURPOSE: To assess the efficacy and safety of a catheter-directed hemorrhoidal dearterialization technique for the management of hemorrhoidal bleeding. MATERIALS AND METHODS: A systematic review and meta-analysis of pubmed, cochrane, and scopus databases was conducted according to the preferred reporting items for systematic reviews and meta-Analysis (PRISMA) guidelines. Clinical studies reporting on catheter-directed hemorrhoidal dearterialization for rectal bleeding were analyzed. RESULTS: Fourteen studies (n = 362) were identified. The mean maximum follow-up duration was 12.1 months (SD, 7.31; range, 1-28; median, 12), and the mean length of hospital stay was 1.5 days (SD, 1.1; range, 0-2.5). The mean technical success was 97.8% (SD, 3.5), and the mean clinical success was 78.9% (SD, 10.5). A statistically significant reduction in the french bleeding score before and after embolization was noted (P = .004). In subgroup analysis, when the coils-only group was compared with the coils and particles group, the average rebleeding rate was 21.5% (n = 111; SD, 18.2; range, 0%-44%) versus 10.05% (N = 108; SD, 4.8; range, 5%-15.7%), respectively (P < .0001). No bowel ischemia/necrosis or anorectal complications were reported. CONCLUSIONS: The current preliminary clinical evidence suggests that catheter-directed hemorrhoidal dearterialization is an effective and safe procedure for the treatment of hemorrhoidal bleeding. The standardization of the technique and the generation of higher level evidence will be required to compare this minimally invasive procedure with more invasive surgical options for patients with grades I-III hemorrhoids and chronic bleeding.
Authors: Miguel Angel De Gregorio; Román Bernal; Juan Jose Ciampi-Dopazo; José Urbano; Alfonso Millera; José Andres Guirola Journal: J Clin Med Date: 2022-05-28 Impact factor: 4.964