International journal of colorectal disease · 2026
Polidocanol foam sclerotherapy for patients with Goligher grade IV hemorrhoidal disease unwilling to undergo surgery: preliminary outcomes from a retrospective study with 6-month follow-up.
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Gravante Gianpiero, De Simone Veronica, Picciariello Arcangelo, Sorge Roberto, Sileri Pierpaolo, Gallo Gaetano
Аннотация
BACKGROUND: Polidocanol foam (PF) sclerotherapy has shown promising results in low- and intermediate-grade hemorrhoidal disease (HD), but evidence in advanced stages remains limited. This study aimed to evaluate patient-reported outcomes following PF sclerotherapy in patients with Goligher grade IV HD who declined surgical treatment.
METHODS: This retrospective analysis included patients with Goligher grade IV HD that declined hemorrhoidectomy after appropriate counseling and underwent 3% PF sclerotherapy between June and October 2025. Outcomes were assessed using symptom-focused subsets derived from the PROM-HISS and HDSS instruments at baseline, 7 days, 30 days, and 6 months. Primary outcome was the change in scores over time. Secondary outcomes included need for additional treatment, complications, and subsequent surgery.
RESULTS: Fifteen patients were included (mean age 58 ± 11 years; 53.3% male). At 6 months, 66.7% of patients requested no further hemorrhoidal treatment. Significant improvements were observed in both scores across all follow-up timepoints (p < 0.05). Pain, bleeding, and prolapse showed the most consistent reductions. One patient (6.7%) required hemorrhoidectomy within 30 days, four patients (26.7%) a second sclerotherapy session. No major complications were observed.
CONCLUSIONS: In selected patients with Goligher grade IV HD who are unwilling or unfit to undergo surgery, PF sclerotherapy may be associated with short-term symptom improvement and may represent a symptom-oriented minimally invasive option for selected patients unwilling or unfit to undergo surgery.
METHODS: This retrospective analysis included patients with Goligher grade IV HD that declined hemorrhoidectomy after appropriate counseling and underwent 3% PF sclerotherapy between June and October 2025. Outcomes were assessed using symptom-focused subsets derived from the PROM-HISS and HDSS instruments at baseline, 7 days, 30 days, and 6 months. Primary outcome was the change in scores over time. Secondary outcomes included need for additional treatment, complications, and subsequent surgery.
RESULTS: Fifteen patients were included (mean age 58 ± 11 years; 53.3% male). At 6 months, 66.7% of patients requested no further hemorrhoidal treatment. Significant improvements were observed in both scores across all follow-up timepoints (p < 0.05). Pain, bleeding, and prolapse showed the most consistent reductions. One patient (6.7%) required hemorrhoidectomy within 30 days, four patients (26.7%) a second sclerotherapy session. No major complications were observed.
CONCLUSIONS: In selected patients with Goligher grade IV HD who are unwilling or unfit to undergo surgery, PF sclerotherapy may be associated with short-term symptom improvement and may represent a symptom-oriented minimally invasive option for selected patients unwilling or unfit to undergo surgery.