Interventional Radiology Should be Competitive-If Haemorrhoids are Arteriovenous Connections, It is Now the Time for Liquids? Commentary on "Superior Rectal Artery Embolisation for Haemorrhoids: What do We Know so Far?"

Introduction

There is no doubt that Emborrhoid is a feasible and safe technique that has proven to be effective in selected cases for the treatment of haemorrhoidal bleeding under local anaesthesia, painless and with no direct trauma to the anorectal canal.

Patients for whom there is a recurrence after surgery, a surgical contraindication or under bi-antiplatelet aggregation/anticoagulation, are particularly eligible. However, Emborrhoid has shown to be not good for external or thrombosed haemorrhoids nor for severely prolapsed haemorrhoids [1].

External haemorrhoids present usually with acute thrombosis, pain, pruritus and mucus discharge. Bleeding and prolapse can also be present. Internal haemorrhoids present usually with bleeding and mucus discharge with variable grades of prolapse, whereas pain, pruritus and faecal seepage are fewer dominant features. With the aim of optimising the results from the haemorrhoidal artery ligation technique (HAL-Doppler), transanal haemorrhoidal dearterialisation with mucopexy (THD-M) was developed with very good results when treating grades II–IV haemorrhoids (reported recurrence of bleeding of 2.1% and a recurrence of prolapse 6.4% in overall results), solving not only the bleeding but also the prolapse at a time in external haemorrhoids [2, 3].

On the one hand, Emborrhoid current approach is still far from these results, but, moreover, Emborrhoid is not treating prolapses in grades III and IV haemorrhoids. This should be considered not only as a technique drawback but also as limitations of Emborrhoid when considering treatment options for patients with high-grade prolapsed haemorrhoids (with a second-look surgery needed for that issue) and, moreover, a possible cause of symptoms recurrence [1,2,3].

CITATION Cardiovasc Intervent Radiol . 2021 May;44(5):686-688. doi: 10.1007/s00270-021-02788-3. Epub 2021 Feb 24