Outcomes of embolization therapy of superior rectal arteries for the management of grade 1 to 3 internal hemorrhoids: a systematic Review of clinical studies

Abstract

Background: Superior rectal artery embolization ("Emborrhoid") offers a catheter-based alternative for grade I-III internal hemorrhoids when office therapies fail or surgery is undesirable.

Methods: Following PRISMA 2020, PubMed and Embase were searched (Jan 2014-Jan 2024). Two reviewers independently screened records, extracted data, and applied RoB 2, ROBINS-I, or an adapted Newcastle-Ottawa Scale. Prespecified outcomes were technical success, clinical success (≥ 2-point fall in bleeding score or equivalent), adverse events, and recurrence. Substantial heterogeneity blocked meta-analysis; results were narratively synthesized.

Results: Twenty-two studies encompassing 810 procedures qualified. Technical success reached 93-100%. Clinical success ranged from 63 to 94%, yielding marked bleeding control and symptom relief. Reported complications were mild and self-limited (pelvic discomfort, nausea, and low-grade fever); no ischemic injury, continence disturbance, or mortality occurred. Recurrence necessitating repeat treatment affected 8-20% of patients, usually when collateral arterial supply persisted. Patient-reported satisfaction exceeded 80% in every series. Only two small, heterogeneous comparative studies versus rubber-band ligation or sclerotherapy were available, precluding a pooled analysis.

Conclusions: Current evidence suggests Emborrhoid is a safe, effective bridge between office procedures and surgery-particularly valuable for frail or anticoagulated patients. Yet small single-center cohorts, disparate techniques, and scarce head-to-head trials limit external validity. Multicenter randomized studies with harmonized outcomes and ≥ 24-month follow-up are required to confirm long-term efficacy, cost-effectiveness, and optimal patient selection.

Keywords: Embolic materials; Hemorrhoidal embolization; Minimally invasive therapy; Patient satisfaction; Recurrence rates; Superior rectal artery; Systematic review.

Fig. 1

PRISA flowchart