Polidocanol foam sclerotherapy in the treatment of hemorrhoidal disease, including in patients with bleeding diss

Paulo Salgueiro

Paulo Salgueiro is specialist in gastroenterologist at CHUdSA and responsible for the Pancreas and Biliary Tract Consultation, Endoscopic Retrograde Cholangiography technique, and vice-coordinator of the Pelvic Floor Multidisciplinary Unit.
Associate Professor at the Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP). He got his Ph.D. in Medical Sciences at ICBAS-UP in November 2022, under the supervision of Professor Fernando de Castro Poças.


Hemorrhoidal disease (HD) is a prevalent condition with a significant toll on patients' quality of life. However, the evidence in the literature about the standard of care treatment for HD is scarce, particularly when it comes to comparing the most established outpatient treatments with the most recent and promising polidocanol foam sclerotherapy (PFS). Before our prospective studies, rubber band ligation (RBL) was the gold-standard office-based treatment against which emerging treatments should be compared. The role of PFS in the treatment of patients with bleeding diss (BD) also required additional studies specifically directed at this patient population.

We conducted a randomized trial comparing the efficacy and safety of PFS and RBL in the treatment of grades I-III HD, which showed the greater efficacy of PFS in achieving complete therapeutic success. Patients treated with PFS required fewer office-based treatment sessions, had lower recurrence rates, and were less likely to present associated complications.

In another prospective multicentric study investigating HD treatment in the vulnerable population of patients with BD, we showed that PFS had similar efficacy and safety in the patient populations with and without BD, despite the more severe HD in the former.

Our results suggest that PFS can become the standard of care in the treatment of HD, even in patients with BD, providing a safe and effective alternative without the need for bleeding prophylaxis or stopping antithrombotic drugs, thus avoiding a possible increase in the thromboembolic risk.


Read the full version at: https://hdl.handle.net/10216/146242