What question did this study set out to answer?

This study aims to evaluate early hemodynamic changes after endoscopic polidocanol foam sclerotherapy and their association with clinical outcomes.

June 10, 2026Open Access

Early hemodynamic changes following endoscopic sclerotherapy for hemorrhoidal disease assessed by transperineal ultrasound and their relationship with clinical outcomes

Key Points

This study aims to evaluate early hemodynamic changes after endoscopic polidocanol foam sclerotherapy and their association with clinical outcomes.
Prospective observational study with patients having Goligher grade I-IV HD treated with endoscopic PF sclerotherapy.
Transperineal ultrasound assessed hemodynamics at baseline, 7 days, and 30 days post-treatment.
Symptoms evaluated using PROM-HISS score, with comparisons over time and by HD severity.
Lower-grade HD patients showed significant reductions in peak systolic velocity and resistance index at both 7 (p < 0.01) and 30 days (p < 0.01).
No significant PSV or RI changes in higher-grade HD; however, end-diastolic velocity increased at 30 days (p = 0.012).
PROM-HISS scores improved at 7 days across all patients, but scores increased again between 7 and 30 days in higher-grade HD.

Abstract

BACKGROUND: Polidocanol foam (PF) sclerotherapy has regained interest as a minimally invasive treatment for hemorrhoidal disease (HD). However, the early hemodynamic effects of sclerotherapy and their relationship with clinical outcomes remain poorly defined. This study aimed to evaluate early local hemodynamic changes following endoscopic PF sclerotherapy using transperineal ultrasound (TPUS) and to explore their association with patient-reported outcome measures (PROMs). METHODS: This prospective observational study included patients with Goligher grade I-IV HD treated with endoscopic PF sclerotherapy. TPUS Doppler assessment of peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI) was performed at baseline, 7 days, and 30 days post-treatment. Symptoms were evaluated using the PROM-HISS score. Hemodynamic and clinical outcomes were compared over time and stratified by HD severity (Goligher I-II vs III-IV). RESULTS: Thirty-seven patients completed follow-up. No significant differences in preoperative PSV were observed between lower- (Goligher I/II) and higher-grade HD (Goligher III/IV). After treatment, patients with lower-grade HD showed a significant reduction in PSV and RI at both 7 and 30 days (p < 0.01), indicating effective modulation of arterial inflow. In contrast, no significant changes in PSV or RI were observed in higher-grade HD, while EDV increased at 30 days (p = 0.012). PROM-HISS scores significantly improved in all patients at 7 days; however, symptom scores increased between 7 and 30 days in higher-grade HD. CONCLUSIONS: PF sclerotherapy induces early short-term hemodynamic changes detectable by TPUS in lower-grade HD, paralleling consistent short-term symptom improvement. In advanced HD, clinical benefit appears transient and not supported by objective vascular remodeling. TPUS emerges as a valuable non-invasive tool for functional assessment, follow-up, and treatment stratification after sclerotherapy.

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