Observation on the effect of transparent cap assisted endoscopic injection of polidocanol foam sclerosing agent at a high dose in treatment of grade Ⅱ-Ⅲ internal hemorrhoids

SHI Jie; LI Wenzhong; ZHOU Yi; ZHOU Qingwen

doi:10.3969/j.issn.1674-3806.2024.10.10

Abstract：Objective To observe the effect of transparent cap assisted endoscopic injection of polidocanol foam sclerosing agent at a high dose in treatment of grade Ⅱ-Ⅲ internal hemorrhoids.Methods A total of 98 patients with grade Ⅱ-Ⅲ internal hemorrhoids who received the treatment of transparent cap assisted endoscopic injection of polidocanol foam sclerosing agent in Chang An Hospital from October 2022 to October 2023 were recruited and divided into conventional-dose group and high-dose group by using random number table method,with 49 cases in each group.The injection dose of polidocanol foam sclerosing agent in the conventional-dose group was 0.5-2.0 mL/injection site,and the injection dose of polidocanol foam sclerosing agent in the high-dose group was more than 2.0-4.0 mL/injection site.The therapeutic effect,treatment-related indicators,the occurrence of postoperative complications and the recurrence were compared between the two groups.The serum inflammatory indicators[tumor necrosis factor-alpha(TNF-α),C-reactive protein(CRP),interleukin-6(IL-6)],anorectal dynamics indicators[rectal maximum tolerated volume(MTV),rectal resting pressure(RRP),anal maximum squeeze pressure(MSP)],anal continence function score,anal sensory function score,and EuroQol five-dimensional questionnaire(EQ-5D)score were compared between the two groups before treatment,1 month after treatment and 3 months after treatment.Results The difference in therapeutic efficacy between the two groups was statistically significant(P＜0.05),and the proportion of the patients cured in the high-dose group was higher than that in the conventional-dose group(79.59％vs 59.18％).The length of hospital stay in the high-dose group was significantly shorter than that in the conventional-dose group(P＜0.05).After treatment,the levels of TNF-α,CRP,IL-6,MTV,MSP,anal continence function scores and anal sensory function scores in both groups showed a downward trend,while the levels of RRP and EQ-5D scores in both groups showed an upward trend,and the changes were greater in the high-dose group(P＜0.05).At 1 month and 3 months after treatment,the levels of TNF-α,CRP,IL-6,MTV,MSP,anal continence function scores and anal sensory function scores in the high-dose group were lower than those in the conventional-dose group,while the RRP level and EQ-5D scores in the high-dose group were higher than those in the conventional-dose group,and the differences were statistically significant(P＜0.05).There was no significant difference in the total incidence of postoperative complications between the two groups(10.20％vs 6.12％;x2=0.544,P=0.461).The follow-up was conducted for 6 months after treatment,and there were no cases of recurrence in the high-dose group,while there were 6 cases of recurrence in the conventional-dose group,and the recurrence rate in the high-dose group was significantly lower than that in the conventional-dose group(0.00％vs 12.24％;x2=6.391,P=0.011).Conclusion Transparent cap assisted endoscopic injection of polidocanol foam sclerosing agent at a high dose can improve the cure rate in treatment of grade Ⅱ-Ⅲ internal hemorrhoids,inhibit the inflammatory response,promote the recovery of anorectal dynamics,improve the anal function,improve the quality of life,and reduce the recurrence rate,and is worthy of clinical recommendation.