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Abstract：
BACKGROUND: Hemorrhoidal artery embolization (Emborrhoid) is a novel method for the treatment of severe hemorrhoidal bleeding. Despite having a technical success rate of 93%-100%, the clinical success ranges between 63% and 94%, with a rebleeding rate of 13.6%.
OBJECTIVE: To evaluate the effectiveness of this procedure in reducing hemorrhoidal flow and hemorrhoidal bleeding.
METHODS: This prospective observational pilot study was conducted at Division of General Surgery 1 and Tertiary Referral Pelvic Floor Center, Treviso Regional Hospital, Italy. In a 2 months period (February-March 2022), consecutive patients with hemorrhoidal bleeding scores (HBSs) ≥ 4, Goligher scores of II or III, failure of non-operative management, and a candidate for Emborrhoid were included. Endoanal ultrasound with eco-Doppler was performed preoperatively and 1 month after the procedure. The primary endpoint was to quantify the changes in arterial hemorrhoidal flow after treatment. The secondary endpoint was to evaluate the correlation between the flow changes and the HBS.
RESULTS: Eleven patients underwent Emborrhoid. The overall pretreatment mean systolic peak (MSP) was 14.66 cm/s. The highest MSP values were found in the anterior left lateral (17.82 cm/s at 1 o\'clock and 15.88 cm/s at 3 o\'clock) and in the posterior right lateral (14.62 cm/s at 7 o\'clock and 16.71 cm/s at 9 o\'clock) quadrants of the anal canal. After treatment, the overall MSP values were significantly reduced (P = 0.008) although the correlation between MSP and HBS changes was weak (P = 0.570). A statistical difference was found between distal embolization compared with proximal embolization (P = 0.047). However, the coil landing zone was not related to symptoms improvement (P = 1.000). A significant difference in MSP changes was also reported between patients with type 1 and type 2 superior rectal artery (SRA) anatomy (P = 0.040). No relationship between hemorrhoidal grades (P = 1.000), SRA anatomy (P = 1.000) and treatment outcomes was found.
CONCLUSIONS: The preliminary findings of this pilot study confirm that Emborrhoid was effective in reducing the arterial hemorrhoidal flow in hemorrhoidal disease. However, the correlation between the post-operative MSP and HBS changes was weak. Hemorrhoidal grade, SRA anatomy and type of embolization were not related to treatment outcomes.
OBJECTIVE: To evaluate the effectiveness of this procedure in reducing hemorrhoidal flow and hemorrhoidal bleeding.
METHODS: This prospective observational pilot study was conducted at Division of General Surgery 1 and Tertiary Referral Pelvic Floor Center, Treviso Regional Hospital, Italy. In a 2 months period (February-March 2022), consecutive patients with hemorrhoidal bleeding scores (HBSs) ≥ 4, Goligher scores of II or III, failure of non-operative management, and a candidate for Emborrhoid were included. Endoanal ultrasound with eco-Doppler was performed preoperatively and 1 month after the procedure. The primary endpoint was to quantify the changes in arterial hemorrhoidal flow after treatment. The secondary endpoint was to evaluate the correlation between the flow changes and the HBS.
RESULTS: Eleven patients underwent Emborrhoid. The overall pretreatment mean systolic peak (MSP) was 14.66 cm/s. The highest MSP values were found in the anterior left lateral (17.82 cm/s at 1 o\'clock and 15.88 cm/s at 3 o\'clock) and in the posterior right lateral (14.62 cm/s at 7 o\'clock and 16.71 cm/s at 9 o\'clock) quadrants of the anal canal. After treatment, the overall MSP values were significantly reduced (P = 0.008) although the correlation between MSP and HBS changes was weak (P = 0.570). A statistical difference was found between distal embolization compared with proximal embolization (P = 0.047). However, the coil landing zone was not related to symptoms improvement (P = 1.000). A significant difference in MSP changes was also reported between patients with type 1 and type 2 superior rectal artery (SRA) anatomy (P = 0.040). No relationship between hemorrhoidal grades (P = 1.000), SRA anatomy (P = 1.000) and treatment outcomes was found.
CONCLUSIONS: The preliminary findings of this pilot study confirm that Emborrhoid was effective in reducing the arterial hemorrhoidal flow in hemorrhoidal disease. However, the correlation between the post-operative MSP and HBS changes was weak. Hemorrhoidal grade, SRA anatomy and type of embolization were not related to treatment outcomes.
摘要：
背景：痔动脉栓塞术（Emborruid）是一种治疗严重痔出血的新方法。尽管有93%-100%的技术成功率，临床成功率在63%到94%之间，再出血率为13.6%。
目的：评估该方法在减少痔流和痔出血方面的有效性。
方法：这项前瞻性观察性试验研究在普外科1区和三级转诊盆底中心进行，特雷维索地区医院,意大利。在2个月内（2022年2月至3月），连续患者痔疮出血评分（HBSs）≥4，Goligher评分为II或III，非操作管理失败，包括一名痔疮候选人。术前和术后1个月进行了超声检查。主要终点是量化治疗后动脉血流的变化。次要终点是评估流量变化与HBS之间的相关性。
结果：11例患者接受了痔疮治疗。总体治疗前平均收缩期峰值(MSP)为14.66cm/s。最高的MSP值在肛管的左前侧（1点17.82cm/s，3点15.88cm/s）和右后侧（7点14.62cm/s，9点16.71cm/s）象限中发现。治疗后,尽管MSP和HBS变化之间的相关性较弱(P=0.570),但总体MSP值显着降低(P=0.008).远端栓塞与近端栓塞比较差异有统计学意义(P=0.047)。然而,线圈着陆区与症状改善无关(P=1.000).在1型和2型直肠上动脉（SRA）解剖结构的患者之间，MSP变化也有显着差异（P=0.040）。痔疮等级之间没有关系（P=1.000），发现SRA解剖结构（P=1.000）和治疗结果。
结论：这项初步研究的初步发现证实，痔疮可有效减少痔疮的动脉血流。然而,术后MSP与HBS变化之间的相关性较弱。痔疮等级,SRA解剖结构和栓塞类型与治疗结果无关。
目的：评估该方法在减少痔流和痔出血方面的有效性。
方法：这项前瞻性观察性试验研究在普外科1区和三级转诊盆底中心进行，特雷维索地区医院,意大利。在2个月内（2022年2月至3月），连续患者痔疮出血评分（HBSs）≥4，Goligher评分为II或III，非操作管理失败，包括一名痔疮候选人。术前和术后1个月进行了超声检查。主要终点是量化治疗后动脉血流的变化。次要终点是评估流量变化与HBS之间的相关性。
结果：11例患者接受了痔疮治疗。总体治疗前平均收缩期峰值(MSP)为14.66cm/s。最高的MSP值在肛管的左前侧（1点17.82cm/s，3点15.88cm/s）和右后侧（7点14.62cm/s，9点16.71cm/s）象限中发现。治疗后,尽管MSP和HBS变化之间的相关性较弱(P=0.570),但总体MSP值显着降低(P=0.008).远端栓塞与近端栓塞比较差异有统计学意义(P=0.047)。然而,线圈着陆区与症状改善无关(P=1.000).在1型和2型直肠上动脉（SRA）解剖结构的患者之间，MSP变化也有显着差异（P=0.040）。痔疮等级之间没有关系（P=1.000），发现SRA解剖结构（P=1.000）和治疗结果。
结论：这项初步研究的初步发现证实，痔疮可有效减少痔疮的动脉血流。然而,术后MSP与HBS变化之间的相关性较弱。痔疮等级,SRA解剖结构和栓塞类型与治疗结果无关。
