Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Dec 25, 2015; 7(19): 1334-1340
Published online Dec 25, 2015. doi: 10.4253/wjge.v7.i19.1334
Cap-assisted endoscopic sclerotherapy for hemorrhoids: Methods, feasibility and efficacy
Ting Zhang, Li-Juan Xu, Jie Xiang, Zhi He, Zhao-Yuan Peng, Guang-Ming Huang, Guo-Zhong Ji, Fa-Ming Zhang
Ting Zhang, Li-Juan Xu, Jie Xiang, Zhi He, Zhao-Yuan Peng, Guang-Ming Huang, Guo-Zhong Ji, Fa-Ming Zhang, Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
Ting Zhang, Li-Juan Xu, Jie Xiang, Zhi He, Zhao-Yuan Peng, Guang-Ming Huang, Guo-Zhong Ji, Fa-Ming Zhang, Key Lab of Holistic Integrative Enterology, Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
Author contributions: Zhang T and Xu LJ contributed equally to this work; Zhang T, Xu LJ, Xiang J, He Z, Peng ZY, Huang GM, Ji GZ and Zhang FM designed the research; Xu LJ, Xiang J, Huang GM and Ji GZ performed the research; He Z and Peng ZY analyzed the data; Zhang T and Zhang FM wrote the paper.
Supported by The Intestine Initiative Foundation, Clinical Science and Technology Foundation of Jiangsu Province, No. BL2014097; the National Science and Technology Major Project, No. 2012BAI06B03; and the National Gastroenterology Research Project, No. 2015BAI13B07.
Institutional review board statement: The study was reviewed and approved by the Second Affiliated Hospital of Nanjing Medical University Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: We declare that there are no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Fa-Ming Zhang, MD, PhD, Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, 121 Jiang Jiayuan, Nanjing 210011, Jiangsu Province, China. fzhang@njmu.edu.cn
Telephone: +86-25-58509883 Fax: +86-25-58509931
Received: September 1, 2015
Peer-review started: September 1, 2015
First decision: October 14, 2015
Revised: October 20, 2015
Accepted: December 3, 2015
Article in press: December 4, 2015
Published online: December 25, 2015
Abstract

AIM: To evaluate the methodology, feasibility, safety and efficacy of a novel method called cap-assisted endoscopic sclerotherapy (CAES) for internal hemorrhoids.

METHODS: A pilot study on CAES for grade I to III internal hemorrhoids was performed. Colon and terminal ileum examination by colonoscopy was performed for all patients before starting CAES. Polypectomy and excision of anal papilla fibroma were performed if polyps or anal papilla fibroma were found and assessed to be suitable for resection under endoscopy. CAES was performed based on the requirement of the cap, endoscope, disposable endoscopic long injection needle, enough insufflated air and sclerosing agent.

RESULTS: A total of 30 patients with grade I to III internal hemorrhoids was included. The follow-up was more than four weeks. No bleeding was observed after CAES. One (3.33%) patient claimed mild tenesmus within four days after CAES in that an endoscopist performed this procedure for the first time. One hundred percent of patients were satisfied with this novel procedure, especially for those patients who underwent CAES in conjunction with polypectomy or excision of anal papilla fibroma.

CONCLUSION: CAES as a novel endoscopic sclerotherapy should be a convenient, safe and effective flexible endoscopic therapy for internal hemorrhoids.

Keywords: Sclerotherapy, Hemorrhoids, Cap-assisted endoscopic sclerotherapy, Colonoscopy, Colon, Papilla fibroma, Hemorrhoidal disease

Core tip: Sclerotherapy is the most effective therapy for grade I or II internal hemorrhoids. Traditional sclerotherapy may cause iatrogenic risk due to misplaced injections. We designed a novel technique called cap-assisted endoscopic sclerotherapy (CAES) for hemorrhoids by flexible endoscopy. Our study demonstrated that CAES is a safe, effective and convenient endoscopic therapeutic strategy for grade I, grade II and partial grade III internal hemorrhoids. The colon preparation and colonoscopy before CAES brought more benefits for patients, including possible polypectomy and excision of anal papilla fibroma under colonoscopy. This study implies the future contribution of endoscopists on hemorrhoidal disease.