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

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. 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. (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. 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.