Introduction: Symptomatic hemorrhoids are the third most common outpatient gastrointestinal diagnosis with considerable disease burden and economic cost. Multiple non-surgical options including Rubber Band Ligation (RBL), Doppler-guided ligation and Infrared Coagulation (IRC) are available, but recurrence rates can be as high as 30%. Most patients do not require invasive surgery, which may have significant associated morbidity and cost. Patients are often seen across multiple specialties including Gastroenterology, General and Colorectal Surgery, leading to high variability in treatment recommendations and therapeutic offerings. The purpose of this study is to highlight a novel, successful multi-disciplinary algorithm involving Interventional Radiology (IR) and Gastroenterology (GI) to treat patients with symptomatic hemorrhoids for non-surgical patients.
Methods: Patients were seen in disease-specific Hemorrhoid Clinic and evaluated for hemorrhoid burden by GI and IR physicians. Following a comprehensive evaluation, patients were counseled regarding traditional minimally invasive treatments and selected patients were also referred for hemorrhoidal artery embolization (HAE) which has emerged as an effective non-surgical treatment for hemorrhoids. Candidates included those who failed prior treatment, on anticoagulation, poor candidates (Inflammatory Bowel Disease), and patient preference. Selected patients underwent outpatient HAE in a collaborative IR Clinic with follow-up performed by GI and IR physicians. Long-term follow-up and patient management were maintained with the GI practice, including screening colonoscopy, based on standard guidelines.
Results: A total of 191 patients were evaluated in GI clinic for symptomatic hemorrhoids. Baseline hemorrhoid symptom score (HSS) was 12.0 and French Bleeding Score (FBS) was 5.2. Of the 191 patients, 144 patients qualified for HAE as per the algorithm and have undergone HAE with 100% technical success. 126 patients have completed 1-month follow-up with significant reductions in HSS and FBS. No significant adverse events were reported.
Discussion: Increased collaborative efforts between GI and IR can supplement care and prevent gaps in treatment for symptomatic hemorrhoids, while maintaining an effective relationship with the patient for long term screening and care.
