Application of Polidocanol Foam Injection Sclerotherapy in Patients with Antithrombotic Therapy Combined with Mixed Hemorrhoid Bleeding: A Retrospective Single-Center Case Series and Narrative Review (with Video).

Purpose: For patients with antithrombotic therapy combined with mixed hemorrhoid bleeding, the contradiction between antithrombotic and hemostatic treatments often requires surgical intervention. However, multi-country guidelines recommend the use of injection sclerotherapy (IST), but there is little research on the application of polidocanol foam IST. The purpose of this study is to explore the retrospective single-center case series experience of polidocanol foam IST in those patients and review the related literature. Patients and Methods: From March 2018 to May 2023, we retrospectively analyzed the clinical data of 7 patients with mixed hemorrhoid bleeding in the General Surgery Department of Yangpu Hospital affiliated with Tongji University. These patients all received antithrombotic treatment and their bleeding could not be stopped by conservative treatment. Finally, they all received polidocanol foam IST. We summarized the single-center clinical application experience of polidocanol foam IST in those patients. Through a literature search, the related literature concerning the application of polidocanol foam IST in patients with antithrombotic therapy combined with mixed hemorrhoid bleeding were reviewed. Results: Seven patients were successfully treated with polidocanol foam IST, and the bleeding stopped. The operation time ranged from 10-30 minutes, and no serious complications occurred. At the 4-week postoperative follow-up evaluation, none of the patients had bleeding again, and hemoglobin significantly increased (106.0±17.4 g/L vs 70.9±19.7 g/L, p=0.004). Four weeks after surgery, the overall clinical efficacy rate reached 100%, with a satisfaction rate of 100%. Through a literature review, three studies were ultimately included for analysis. Conclusion: Polidocanol foam IST is a relatively safe and effective method for patients receiving antithrombotic therapy combined with mixed hemorrhoid bleeding. However, larger multicenter prospective studies are needed before this is the preferred treatment for such patients.