Hemorrhoidal Artery Embolization (Emborrhoid): A New Non-Surgical Treatment Option for Internal Hemorrhoids
Department of Radiology, Shaare Zedek Medical Center, Israel
PURPOSE: Internal hemorrhoids are an extremely prevalent disease, with chronic bleeding leading to significant impairment in quality of life. Conservative treatment options are limited in their effectiveness and durability, and traditional surgical options carry potential morbidity and prolonged recovery.
New understanding of internal hemorrhoid pathophysiology has led to the insight that symtomotology is primarily due to arterial hyperperfusion to the hemorrhoidal cushions. It is on this basis that emborroid was developed, particularly for those patients at high surgical risk due to anti-coagulation therapy or inflammatory bowel disease. The superior rectal artery is the dominant supply to the hemorrhoidal cushions, making its branches the target for embolization. Rich collateral arterial supply to the rectum itself, allows for safe embolization, and limited risk of ischemia.
MATERIALS AND METHODS: Between December 2017 and July 2018, 4 patients underwent the emborrhoid procedure. 1 patient had undergone previous surgery with recurrence of symptoms. 2 patients had Crohn`s Disease and 1 patient was taking chronic anticoagulation. All were considered high risk for surgical intervention. Trans-arterial embolization of all visualized branches of the superior rectal artery was performed in all 4 patients. All patients were seen in clinic follow up 1-3 months after the emborrhoid procedure.
3 of 4 patients had significant subjective reduction in their chronic rectal bleeding at clinic follow up. 1 patient experienced severe pain for a period of 2 months after his procedure, likely due to use of particle embolization; the subsequent 3 patients were treated with platinum microcoils only.
Emborrhoid is a promising new minimally invasive treatment option for patients suffering from bleeding internal hemorrhoids. It is appropriate for patients at high surgical risk and potentially for those who are seeking an alternative to the potential morbidity and prolonged recovery associated with traditional surgical options.