Cap-assisted endoscopic sclerotherapy for hemorrhoids: Methods, feasibility and efficacy

Abstract

Aim: To evaluate the methodology, feasibility, safety and efficacy of a novel method called cap-assisted endoscopic sclerotherapy (CAES) for internal hemorrhoids.

Methods: A pilot study on CAES for grade I to III internal hemorrhoids was performed. Colon and terminal ileum examination by colonoscopy was performed for all patients before starting CAES. Polypectomy and excision of anal papilla fibroma were performed if polyps or anal papilla fibroma were found and assessed to be suitable for resection under endoscopy. CAES was performed based on the requirement of the cap, endoscope, disposable endoscopic long injection needle, enough insufflated air and sclerosing agent.

Results: A total of 30 patients with grade I to III internal hemorrhoids was included. The follow-up was more than four weeks. No bleeding was observed after CAES. One (3.33%) patient claimed mild tenesmus within four days after CAES in that an endoscopist performed this procedure for the first time. One hundred percent of patients were satisfied with this novel procedure, especially for those patients who underwent CAES in conjunction with polypectomy or excision of anal papilla fibroma.

Conclusion: CAES as a novel endoscopic sclerotherapy should be a convenient, safe and effective flexible endoscopic therapy for internal hemorrhoids.

Keywords: Cap-assisted endoscopic sclerotherapy; Colon; Colonoscopy; Hemorrhoidal disease; Hemorrhoids; Papilla fibroma; Sclerotherapy.

Figure 1

Illustration of cap-assisted endoscopic sclerotherapy.

Figure 2

Procedures of cap-assisted endoscopic sclerotherapy for internal hemorrhoids and the excision for anal papilla fibroma. A: Internal hemorrhoids with retroflection of the endoscope; B: The anal region under cap-assisted endoscopic view; C: Internal hemorrhoids and anal papilla fibroma under cap-assisted endoscopic view with enough insufflated air; D: The disposable endoscopic long injection needle through operating channel; E: Injection of lauromacrogol into submucosa of internal hemorrhoids with the cap-assisted endoscopic view; F: Injecting of lauromacrogol into submucosa of internal hemorrhoids close to papilla fibroma before dissection; G: Dissection of anal papilla fibroma (confirmed by the followed pathology) after cap-assisted endoscopic sclerotherapy (CAES); H: No bleeding after CAES and dissection of anal papilla lesion before ending all procedures.