Sclerotherapy Using Aluminum Potassium Sulfate and Tannic Acid (ALTA) for Haemorrhoids in Patients With Liver Cirrhosis

Abstract

Background Symptomatic haemorrhoids in liver cirrhosis are difficult to handle due to rich collateral circulation and possible concomitant coagulo-therapy. Objectives The purpose of this study was to investigate the efficacy and safety of ALTA sclerotherapy in treating symptomatic haemorrhoids in patients with liver cirrhosis and to demonstrate the differences of blood flow in hemorrhoidal tissue in patients with liver cirrhosis in vivo, using transanal ultrasonography. Patients and Methods Eleven patients with liver cirrhosis and haemorrhoidal disease were included in this study. The blood flow in the haemorrhoids was identified using three-dimensional power Doppler angiography (3D-PDA). All patients performed ALTA sclerotherapy. Results All patients’ symptoms (prolapse and/or bleeding) improved. However, two cases re-prolapsed during five years. Although two patients experienced slight bleeding after treatment and three patients experienced retention of ascites, there were no serious complications. 3D-PDA showed higher or lower vascularization in haemorrhoidal tissue in patients with liver cirrhosis. The prevalence of anorectal varices and haemorrhoids in cirrhotic patients had no association to Child-Pugh’s grading. Two patients with hyper-vascularity in haemorrhoidal tissue experienced slight bleeding after treatment. Conclusions ALTA sclerotherapy could bring an acceptable outcome for haemorrhoidal patients concurrent with liver cirrhosis. Using transanal ultrasonography, we could visualize the difference of blood flow in the haemorrhoid plexus and anorectal varices in vivo. This might be useful for treatment of haemorrhoids for patients with liver cirrhosis. We confirmed the efficacy and safety of ALTA sclerotherapy for haemorrhoidal patients with liver cirrhosis. Using 3D-PDA, we could visualize three-dimensionally the hemorrhoid plexus in patients with liver cirrhosis.