Efficacy and Safety of Polidocanol Foam 3% in the Treatment of II Degree Hemorrhoidal Disease (SCLEROFOAM)

September 11, 2021 updated by: Societa Italiana di Chirurgia ColoRettale

A Multicentre, Open-label, Single-arm Phase II Trial on the Efficacy and Safety of Sclerotherapy Using 3% Polidocanol Foam to Treat Second-degree Hemorrhoidal Disease

Hemorrhoidal disease (HD) is one of the oldest and most common proctologic diseases that has been described with an estimated prevalence between 4.4% and 86%. Despite the proposal of three mechanisms that might underlie haemorrhoidal development - the varicose vein theory, the vascular hyperplasia theory and the sliding anal-lining theory, the exact pathophysiology of symptomatic hemorrhoid disease is poorly understood.

HD seems to be the most common cause for rectal bleeding, or hematochezia, and the second most frequent cause for severe rectorrhagia after diverticulitis. The blood is bright red and coats the stool at the end of defection. Other symptoms include pain, mucous discharge, itching or the sensation of tissue prolapse.

The most widely accepted classification is the Goligher classification:

  • Grade I: hemorrhoids bleed but do not prolapse out of the anal canal;
  • Grade II: hemorrhoidal cushions prolapse outside of the anal canal on straining or during bowel movements, but reduce spontaneously;
  • Grade III: hemorrhoidal cushions prolapse outside the anal canal on straining and require manual reduction;
  • Grade IV: hemorrhoidal prolapse is irreducible even with manipulation

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

As reported by the guidelines of the Italian Society of Colorectal Surgery, in case of failure of conservative therapies the most common outpatient treatments for first- and second-degree Hemorrhoidal Disease (HD) are rubber band ligation and sclerotherapy.

Sclerotherapy causes an inflammatory reaction with local sclerosis of the submucosal tissue and a consequent fixation of the haemorrhoidal tissue to the underlying tissue. Moreover, the effect of sclerosing solutions is that of making vascular damage via producing endothelial injury.

A 100% improvement in bleeding was reported in patients with II and grade III hemorrhoids, and a complete resolution of the condition was described in 69% of non-selected patients, 52% in grade III and 88% in grade I. Resolution of prolapse was reported in 90-100% of patients affected by grade II hemorrhoids. Complications are rare but serious, and include impotence, irreversible necrotizing fasciitis and abdominal compartment syndrome [31-33]. In Germany, sclerotherapy with liquid agents is considered the first choice in treating grade I hemorrhoids. The only approved medical product by German authorities is polidocanol (Lauromacrogol 400 (INN), H3C-(CH2)11-(O-CH2-CH2)n∼9-OH), produced by Chemische Fabrik Kreussler & Co. GmbH.

In Italy, this drug is known as Atossisclerol 3%. The polidocanol is a non-ionic detergent made up of a chain of hydrophilic polyethylene oxide mixed with aliphatic hydrophobic dodecyl alcohol and it is recommended for first- and second-degree HD. The effects of polidocanol are similar to those of phenol oil but less number of side effects.

Based on these experiences, Karl-Heinz Moser introduced the use of polidocanol foam in the treatment of grade I hemorrhoids. In 2013, the same author published the results of a randomized, controlled, single blind, multicentre trial on the efficacy and safety of sclerotherapy with polidocanol foam in comparison with liquid sclerosant agents in treating grade I hemorrhoids [28]. In the foam group success rate after one sclerotherapy session was 88%, while success rate among patients treated with liquid polidocanol was 69%. Furthermore, patients treated with foam were more satisfied than those treated with liquid polidocanol (99% vs. 84% p=0.009). Finally, the quantity of polidocanol injected in the foam group was significantly lower (p<0.001), as well as the number of sessions requested (p<0.001).

In summary, according to the authors, these results suggest that polidocanol foam can be used as the treatment of choice in grade I HD.

The aim of this study is to evaluate the efficacy and safety of sclerotherapy with 3% polidocanol foam (PF) on patients affected by second-degree HD.

Study Type

Interventional

Enrollment (Actual)

183

Phase

  • Phase 2

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Italy
      • Catanzaro, Italy, 88100
        • University of Catanzaro

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

14 years to 71 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  1. Patients above 18 and below 75 years of age with a confirmed diagnosis of second-degree HD (proctological examination, proctoscopy and, if required, colonoscopy)
  2. Patients who report persistent perianal bleeding as a typical symptom of second-degree HD
  3. Informed consent from each patient must be obtained
  4. Participating centres will be asked to confirm that they have gained formal approval at their site

Exclusion Criteria:

  1. Previous anal surgical procedures
  2. Previous sclerotherapy or rubber band ligation in the last 12 months
  3. Positive pregnancy test
  4. Patients with inability to return for postoperative control visits, to sign the informed consent or to fill out the required clinical diary
  5. Breast-feeding
  6. Known allergy to polidocanol
  7. Acute perianal thrombosis
  8. Anal fistula
  9. Anal fissure
  10. Proctitis
  11. Fecal incontinence
  12. Coagulation disorders
  13. Anticoagulant therapy
  14. Known HBV, HCV and HIV infection
  15. Acite Crohn's disease or Ulcerative colitis
  16. Diabetes mellitus I and II
  17. COPD
  18. Any kind of tumour
  19. Previous pelvic radiotherapy

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Polidocanol 3% Foam
Patients enrolled in the study, according to the inclusion and exclusion criteria, will undergo sclerotherapy performed with polidocanol foam (Atossisclerol® 3%, Chemische Fabrik Kreussler & Co. GmbH, Wiesbaden, Germany).
Drug: Polidocanol foam (Atossisclerol® 3%)
The procedure will be performed in the Sims position or lithotomy position. A modified Blonde-Blanchard technique will be adopted, with the tangential injection of polidocanol foam into the submucosa of the apex of each hemorrhoidal pile, without exceeding three piles, and using a self-lighting open-ended anoscope and a 20-G needle in order to reduce bleeding

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Success Rate 1
Time Frame: 12 months follow-up

To establish the success rate after one sclerotherapy session, in terms of complete resolution of bleeding episodes one week after the injection

Bleeding will be assessed using both the Hemorrhoidal Disease Symptoms Score and the Giamundo score.

Rørvik HD et al (2019) Hemorrhoidal Disease Symptom Score and Short Health ScaleHD: New Tools to Evaluate Symptoms and Health-Related Quality of Life in Hemorrhoidal Disease. Dis Colon Rectum; 62:333-342

Giamundo et al (2018) Doppler-guided hemorrhoidal dearterialization with laser (HeLP): a prospective analysis of data from a multicenter trial. Tech Coloproctol; 25:635-643
12 months follow-up

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Success Rate 2
Time Frame: 12 months follow-up

To establish the success rate in terms of partial or complete resolution of the symptoms

Symptoms will be assessed using the Hemorrhoidal Disease Symptom Score described by Rorvik HD
12 months follow-up
Number of outpatient sessions
Time Frame: 12 months follow-up
To evaluate the average number of outpatient sessions necessary for treatment success
12 months follow-up
Rate of complications - adverse events
Time Frame: 6 months follow-up
To establish the rate of complications
6 months follow-up
Quality of Life
Time Frame: 12 months follow-up

Short Health Scale HD

4 questions with 7-point Liker scale each (1 = very dissatisfied, 7 = very satisfied)

Minimum = 4

Maximum = 28
12 months follow-up
To establish the average time required to reach autonomy
Time Frame: 12 months follow-up
We considered autonomy as the return to normal activity: it includes also the return to work apart from cases of retired patients in which we considered it as the complete return to daily activities
12 months follow-up

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Societa Italiana di Chirurgia ColoRettale

Collaborators

SICCR - Gaetano Gallo

Investigators

  • Principal Investigator: Gaetano Gallo, MD, Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro 88100, Italy

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 2, 2019

Primary Completion (Actual)

June 2, 2019

Study Completion (Actual)

June 2, 2020

Study Registration Dates

First Submitted

December 29, 2018

First Submitted That Met QC Criteria

January 1, 2019

First Posted (Actual)

January 3, 2019

Study Record Updates

Last Update Posted (Actual)

September 17, 2021

Last Update Submitted That Met QC Criteria

September 11, 2021

Last Verified

September 1, 2021

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 274/2018

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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