Comparing Superior Rectal Artery Embolization with Other Treatments for Bleeding Hemorrhoidal Disease

What this Trial Is About

Hemorrhoidal disease HD is a common anorectal condition that causes bleeding and discomfort. Researchers are evaluating Superior Rectal Artery Embolization SRAE, a minimally invasive treatment that avoids damage to the sphincter and anorectal mucosa. This randomized controlled trial aims to confirm the benefits of SRAE and define its role compared to other treatments like Rubber Band Ligation RBL and Doppler-Guided Hemorrhoidal Artery Ligation DG-HAL, especially in patients with or without antiplatelet or anticoagulation therapy. Participants will be assigned to one of four groups those without anticoagulation therapy receiving RBL or SRAE, and those with anticoagulation therapy receiving DG-HAL or SRAE. RBL involves applying rubber bands to hemorrhoids during outpatient visits, with up to three bands per session and repeat sessions every six weeks. SRAE is performed under local anesthesia during a one-day hospital stay, where an interventional radiologist blocks blood flow in hemorrhoidal arteries using microcoils. If SRAE fails after 12 weeks, a repeat procedure including additional artery embolization may be done. DG-HAL is also done under anesthesia during a one-day stay, using Doppler guidance to locate and ligate hemorrhoidal arteries via a proctoscope. During the study, participants will be monitored for symptom control at baseline, three months, and up to 12 months. Researchers will assess patient-reported effectiveness, clinical outcomes, complications, need for re-intervention, and fecal incontinence. The study involves evaluations through clinical visits and questionnaires to track bleeding and symptom relief. The total participation duration can extend up to one year, allowing long-term follow-up of treatment results and safety.

Evaluation of Superior Rectal Arterial Embolization in Hemorrhoidal Disease