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Clinical Outcomes Following Rectal Artery Embolisation for the Treatment of Internal Haemorrhoids: A Systematic Review and Meta-Analysis

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Abstract

Objectives

Haemorrhoidal disease (HD) is a common anorectal disorder which can substantially impair quality of life. Rectal artery embolisation (RAE) is a recently described technique for the management of HD, however, its clinical efficacy and safety are unclear at present. The objective of this systematic review and meta-analysis is to evaluate the clinical outcomes following RAE.

Methods

The PubMed, MEDLINE and EMBASE databases were searched for studies specifying the management of haemorrhoids with RAE from January 2000 to October 2021. Primary outcomes were: French bleeding score (FBS), Visual analogue scale (VAS) for pain, general quality of life (QoL) score, and the Goligher prolapse score (GPS). Secondary outcomes were technical success, clinical success, postoperative complications, and technical outcomes. A random-effects meta-analysis was conducted. Study heterogeneity was evaluated, and sensitivity analysis was performed.

Results

Thirteen eligible studies were identified including 381 patients. Rectal artery embolisation was associated with improvements in the FBS (mean difference [MD] 2.66; 95% confidence interval [CI] 2.10–3.23), VAS (MD 1.92; 95% CI 1.58–2.27) and QoL (MD 1.41; 95% CI 1.20–3.80), although the grade of internal haemerrhoids increased with uncertain clinical significance (MD 0.30; 95% CI 0.23–0.36). Technical success was achieved in almost all procedures (99%; 95% CI 94–100%) however clinical efficacy was lower (82%; 95% CI 73–89%). Procedural duration and radiation exposure were heterogeneous. No major complications occurred.

Conclusion

RAE demonstrates early clinical efficacy with low rates of peri-procedural complications or morbidity. RAE is a promising addition to the treatment options available for HD and warrants ongoing research.

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Funding

The research received no specific grants from any funding agency in the public, commercial, or non-for-profit sectors.

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Authors and Affiliations

  1. Western Hospital, Footscray, Melbourne, VIC, 3011, Australia

    Minhtuan Nguyenhuy

  2. Peninsula Health, Frankston, VIC, 3199, Australia

    Yifan Xu

  3. Interventional Radiology Service, Northern Health Radiology, Epping, VIC, 3076, Australia

    Hong Kuan Kok

  4. Department of Interventional Radiology, Monash Health, Clayton, VIC, 3168, Australia

    Julian Maingard & Hamed Asadi

  5. Department of General Surgery, Eastern Health, Box Hill, VIC, 3128, Australia

    Shantanu Joglekar

  6. Department of Interventional Radiology, St Vincent’s Melbourne, Fitzroy, VIC, 3065, Australia

    Ashu Jhamb

  7. Department of Interventional Radiology, Austin Health, Heidelberg, VIC, Australia

    Mark Brooks & Hamed Asadi

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  1. Minhtuan Nguyenhuy
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Correspondence to Minhtuan Nguyenhuy.

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Nguyenhuy, M., Xu, Y., Kok, H.K. et al. Clinical Outcomes Following Rectal Artery Embolisation for the Treatment of Internal Haemorrhoids: A Systematic Review and Meta-Analysis. Cardiovasc Intervent Radiol 45, 1351–1361 (2022). https://doi.org/10.1007/s00270-022-03154-7

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  • DOI: https://doi.org/10.1007/s00270-022-03154-7

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