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Background and objectives <p>Cap-assisted endoscopic sclerotherapy (CAES) via a long needle optimizes the visualization of operation field and enables precise injection of sclerosant, yet evidence regarding its application in high-grade internal hemorrhoids (HDs) remains limited. This study aims to evaluate the efficacy and safety of CAES therapy for bleeding-predominant grade III symptomatic internal HDs, and explore potential risk factors associated with postoperative bleeding persistence and recurrence.</p> Methods <p>This single-arm retrospective observational study included 82 patients with bleeding-predominant grade III internal HDs who underwent a single CAES procedure by the injection of liquid polidocanol via a long needle. Treatment efficacy was assessed at 3&#xa0;months post-CAES using the conventional Hemorrhoid Disease Severity Score (HDSS; based on the frequency of symptoms, including bleeding) and the score of the intensity dimension of the bleeding symptom. Bleeding recurrence was monitored during follow-ups. Logistic regression analysis was employed to explore potential risk factors associated with bleeding outcomes.</p> Results <p> (1) The overall efficacy rate was 85.4%. The effective rates for bleeding and prolapse symptoms were 96.3% and 58.2%, respectively. (2) During a follow-up of 24&#xa0;months, the bleeding recurrence rate was 25.3% (20/79). (3) Exploratory logistic regression analysis suggested that a high pre-CAES bleeding intensity score (odds ratio [OR] = 2.887, <i>p</i> = 0.030) was significantly associated with non-excellent outcome (i.e., persistent bleeding); meanwhile, a high pre-CAES bleeding intensity score (OR = 3.981, <i>p</i> = 0.012) and a high post-CAES bleeding frequency score (OR = 3.803, <i>p</i> = 0.006) were significantly associated with post-CAES bleeding recurrence. (4) No severe complications were reported.</p> Conclusions <p>CAES with long-needle injection of polidocanol may serve as an effective and safe therapeutic option for managing bleeding symptom in grade III internal HDs. The higher bleeding-associated scores, which encompass both bleeding frequency and intensity, may represent potential risk factors for persistent or recurrent bleeding after the CAES procedure.</p>

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Cap-assisted endoscopic sclerotherapy for bleeding-predominant grade III hemorrhoids: efficacy and risk factor analysis focusing on two dimensions of bleeding score

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月20日

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  • Gao-jue Wu,
  • Yating Xun,
  • Siyan Yu,
  • Xuejun Tang,
  • Yan Jin

摘要

Background and objectives

Cap-assisted endoscopic sclerotherapy (CAES) via a long needle optimizes the visualization of operation field and enables precise injection of sclerosant, yet evidence regarding its application in high-grade internal hemorrhoids (HDs) remains limited. This study aims to evaluate the efficacy and safety of CAES therapy for bleeding-predominant grade III symptomatic internal HDs, and explore potential risk factors associated with postoperative bleeding persistence and recurrence.

Methods

This single-arm retrospective observational study included 82 patients with bleeding-predominant grade III internal HDs who underwent a single CAES procedure by the injection of liquid polidocanol via a long needle. Treatment efficacy was assessed at 3 months post-CAES using the conventional Hemorrhoid Disease Severity Score (HDSS; based on the frequency of symptoms, including bleeding) and the score of the intensity dimension of the bleeding symptom. Bleeding recurrence was monitored during follow-ups. Logistic regression analysis was employed to explore potential risk factors associated with bleeding outcomes.

Results

(1) The overall efficacy rate was 85.4%. The effective rates for bleeding and prolapse symptoms were 96.3% and 58.2%, respectively. (2) During a follow-up of 24 months, the bleeding recurrence rate was 25.3% (20/79). (3) Exploratory logistic regression analysis suggested that a high pre-CAES bleeding intensity score (odds ratio [OR] = 2.887, p = 0.030) was significantly associated with non-excellent outcome (i.e., persistent bleeding); meanwhile, a high pre-CAES bleeding intensity score (OR = 3.981, p = 0.012) and a high post-CAES bleeding frequency score (OR = 3.803, p = 0.006) were significantly associated with post-CAES bleeding recurrence. (4) No severe complications were reported.

Conclusions

CAES with long-needle injection of polidocanol may serve as an effective and safe therapeutic option for managing bleeding symptom in grade III internal HDs. The higher bleeding-associated scores, which encompass both bleeding frequency and intensity, may represent potential risk factors for persistent or recurrent bleeding after the CAES procedure.