Polidocanol foam sclerotherapy in the treatment of hemorrhoidal disease in patients with bleeding disorders: a multicenter, prospective, cohort study.

BACKGROUND: The management of hemorrhoidal disease (HD) in patients with bleeding disorders (BD) is challenging. Polidocanol foam sclerotherapy (PFS) is associated with a low rate of bleeding complications. The aim of this study was to compare the efficacy and safety of PFS in the treatment of HD in patients with and without BD. METHODS: This prospective, multicenter, cohort study enrolled patients with (group B) and without (group A) BD, with symptomatic internal HD grades I-III over an 18-month period. All patients were treated with PFS. Patients with congenital BD did not undergo prior replacement therapy and those with acquired BD due to antithrombotic drugs, did not discontinue therapy. Efficacy outcomes included therapeutic success and HD recurrence during a 1-year follow-up period. To evaluate safety the complications related to PFS were recorded. RESULTS: We included 228 patients (group A: 155, group B: 73; male/female: 114/114; mean age: 59.4 ± 15.9 years). The baseline hemorrhoidal disease bleeding grade (p < 0.001) and Sodergren hemorrhoidal symptom severity score (p = 0.019) were higher for group B. The overall therapeutic success rate was 93.4% with an average number of sessions of 1.51 ± 0.74, significantly higher for group B (1.68 ± 0.86 vs 1.43 ± 0.65, p = 0.013). Complications occurred in 11.4% of the patients, with bleeding reported in 4.8%. The majority of complications were mild (96.2%). No significant differences between the two groups were observed for therapeutic success, recurrence, or complication rate. CONCLUSIONS: Patients with BD may have more symptomatic HD at baseline. Even so, PSF showed similar effectiveness and safety in patients with BD compared to patients without BD.

Hydatid Cyst Diagnosed by Endoscopic Ultrasound.

A 69-year-old female with unremarkable past history underwent endoscopy for dyspepsia. She denied weight loss or anorexia. Upper endoscopy revealed a bulge in the lesser curvature and posterior wall of the stomach with 4-5 cm. Endoscopic ultrasound was performed which showed a heterogeneous lesion, anechogenic in the major part, with a floating membrane inside, the greatest diameter of 90.8 × 17.2 mm, originated in the left liver lobe. Surgical resection was performed. Pathologic examination revealed a cystic lesion with an acellular thick fibrous wall, surrounded by a conspicuous inflammatory reaction. The cyst wall revealed a characteristic lamellar pattern of the fibers. In the internal surface of the lesion, there were remains of membranous structures, amidst which a vestigial Protoscolex was noted. In the presented case, a floating membrane was observed, which is a pathognomonic feature, establishing the diagnosis of hydatid cyst type 3. Fine needle aspiration guided by ultrasound was not performed due to the certainty in the diagnosis. To the authors' knowledge, these are the first images by endoscopic ultrasound of hydatid cyst of liver presented as a bulge in the stomach with pathognomonic features, which allowed the definitive diagnosis with no need for further diagnostic tests.

The importance of ultrasound findings in the study of anal pain.

OBJECTIVE: Endoanal ultrasonography can detect organic causes of anal pain without pathology on physical examination. The aim of this study is to evaluate the importance of endoanal ultrasonography in the diagnosis and therapeutic management of idiopathic and functional anal pain. MATERIAL AND METHODS: Retrospective study, between 15 March 2005 and 15 June 2008, of all patients with proctalgia and normal examination or with alterations not responsible for anal pain at proctologic exam that have undergone an endoanal ultrasonography. RESULTS: A total of 90 patients were analyzed, with a mean age of 50.5 years, 58% were female. Twenty-three patients had functional anal pain clinic criteria. Endoanal ultrasonography revealed alterations in 49% of patients. The primary findings were changes in sphincters in 14 patients, followed by anal sepsis in 12 patients, anal fissure in 10 patients, perirectal lesions in 6 patients and ulcer of the anal canal in 2 patients. Of the patients with sphincter defects, 5 patients had criteria of chronic anal pain. In this group of patients, no differences were found in manometric and defecographic results between the different ultrasound abnormalities. CONCLUSIONS: The endoanal ultrasonography detected occult organic lesions to proctologic examination, in half the patients with anal pain. Ultrasound abnormalities were found in 22% of patients with functional anal pain. However, there was no correlation between ultrasound findings and physiological studies, and therefore could not find etiological or pathogenic factors of functional anal pain.

Importancia de los hallazgos ecográficos en el dolor anal / No disponible

Objetivo: la ecografía endoanal puede detectar causas orgánicasen el dolor anal sin patología en la exploración física. El objetivode este estudio es evaluar la importancia de la ecografía endoanalen el diagnóstico y en el abordaje terapéutico del dolor analidiopática y funcional.Material y métodos: estudio retrospectivo realizado entre el15 de marzo de 2005 y el 15 de junio de 2008, en todos los pacientesreferenciados para hacerse la ecografía endoanal, debido adolor anal con exploración física normal o sin alteraciones que justifiquenel dolor anal.Resultados: analizamos 90 pacientes con edad media de50,5 años, 58% mujeres. Veintitrés pacientes presentaban criteriosde dolor anal funcional. La ecografía endoanal reveló alteracionesen el 49% de los casos. Las alteraciones más frecuentesfueron las alteraciones esfinterianas, en 14 pacientes,seguido de sepsis anal, en 12 pacientes, de fisura anal, en 10pacientes, de las lesiones perirrectales, en 6 pacientes y de úlceradel canal anal, en 2 pacientes. De los pacientes con alteracionesesfinterianas, 5 pacientes tenían criterios de dolor crónico.En este grupo de pacientes, no se encuentran diferenciasen los hallazgos manométricos y defecográficos entre las diferentesalteraciones ecográficas.Conclusiones: la ecografía endoanal detectó lesiones estructuralesno sospechadas en el examen físico en la mitad de los enfermoscon dolor anal. Se han encontrado alteraciones ecográficasen el 22% de los pacientes con dolor anal funcional. Sinembargo, no se encontró correlación entre los hallazgos ecográficosy los estudios fisiológicos, así que no fue posible encontrar factoresetiológicos o patogénicos del dolor anal funcional(AU)

Objective: endoanal ultrasonography can detect organic causesof anal pain without pathology on physical examination. Theaim of this study is to evaluate the importance of endoanal ultrasonographyin the diagnosis and therapeutic management of idiopathicand functional anal pain.Material and methods: retrospective study, between 15March 2005 and 15 June 2008, of all patients with proctalgiaand normal examination or with alterations not responsible foranal pain at proctologic exam that have undergone an endoanalultrasonography.Results: a total of 90 patients were analyzed, with a meanage of 50.5 years, 58% were female. Twenty-three patients hadfunctional anal pain clinic criteria. Endoanal ultrasonography revealedalterations in 49% of patients. The primary findings werechanges in sphincters in 14 patients, followed by anal sepsis in 12patients, anal fissure in 10 patients, perirectal lesions in 6 patientsand ulcer of the anal canal in 2 patients. Of the patients withsphincter defects, 5 patients had criteria of chronic anal pain. Inthis group of patients, no differences were found in manometricand defecographic results between the different ultrasound abnormalities.Conclusions: the endoanal ultrasonography detected occultorganic lesions to proctologic examination, in half the patientswith anal pain. Ultrasound abnormalities were found in 22% ofpatients with functional anal pain. However, there was no correlationbetween ultrasound findings and physiological studies, andtherefore could not find etiological or pathogenic factors of functionalanal pain(AU)