The Treatment with Sclerotherapy Foam of Hemorrhoidal Disease (HD): Do We Always Have to Use the Same Concentration?

Introduction, Objectives, and/or Purpose: Sclerotherapy with foam induces an inflammatory reaction with sclerosis of the submucosal tissue: the aim of this study is to evaluate what is the best concentration with polidocanol foam prepared using medical device (Varixio) for the different types of degree HD.

Methods: A total of 100 patients (70 females and 30 males) of an average age of 37 years old (range 24- 55) with symptomatic second -third and fourth HD underwent a multiple sessions (at least 3 sessions) between September 2020 and September 2021. We used medical device (Varixio) for the preparation of the foam in a standardized mode (always polidocanol): III degree 2% II degree 3%. HSS and Vazey score were investigated every 4 week for 1 year. We have performed endoscopic examination with flexible endoscope on each patient before sclerotherapy, monitoring the improvement of the quality of life during the follow-up. The quantity of injected foam per hemorroidal mass was never higher than 2 cc, with a maximum of 6 cc during each session. Each session has an average duration of 8 minutes (range 6-12 minutes). Each procedure was carried on every 20 days, without complications.

Results: No intraoperative complications occurred, all patients resumed their normal daily activities the same day of the procedure. The greater it was the degree of HD, more procedures have been performed; compared to our previous experience (always 3% polidocanol) using lower concentration (with foam standardized prepared using medical device, Varixio), we have deleted the local effects post sclerotherapy (pain, discomfort tenesmus) presents above in the III degree. Maybe this is possible using a foam standardized with medical device (Varixio), but more study will be needed.

Conclusion(s): Our experience shows that the greater is the degree of HD, better is the use of low concentration for avoid local effects.