Expert consensus on endoscopic sclerotherapy injection for internal hemorrhoids (2025, Guangzhou)

doi:10.3877/cma.j.issn.2095-7157.2025.04.003

Abstract

Abstract:

Hemorrhoidal disease is the most common anorectal condition, with internal hemorrhoids being the predominant subtype.Since the establishment of the Internal Hemorrhoid Diagnosis and Treatment Collaboration Group under the Digestive Endoscopy Branch of the Chinese Medical Association in 2019, minimally invasive endoscopic treatment for internal hemorrhoids has developed rapidly with the promotion of numerous clinical endoscopists.In recent years, the multifaceted advantages of this technique have been well demonstrated, and it has been gradually implemented at various levels of medical institutions across China.In 2021, the Collaboration Group released the Chinese Guidelines and Expert Consensus on Gastrointestinal Endoscopic Diagnosis and Treatment of Internal Hemorrhoids (2021), which systematically clarified the clinical value of endoscopic treatment for internal hemorrhoids, established a standardized operational framework, and provided a solid theoretical basis for clinical practice.As the technique has become more widely adopted, endoscopists have encountered a number of practical issues in daily practice that call for further refinement and clarification.In 2024, the Internal Hemorrhoid Collaboration Group of the Digestive Endoscopy Branch of the Chinese Medical Association convened experts to discuss and update the previous consensus, resulting in the Expert Consensus on Minimally Invasive Endoscopic Treatment of Internal Hemorrhoids (Guangzhou, 2025), hereinafter referred to as "the Consensus". This Consensus proposes a new endoscopic classification for internal hemorrhoids, namely the PBR classification, and updates several key aspects, including endoscopic sclerotherapy for internal hemorrhoids and the management of postoperative complications.On this basis, in order to further refine and standardize endoscopic sclerosing agent injection for internal hemorrhoids-particularly with respect to technical details, perioperative management, and the handling of postoperative complications-the Hemorrhoid Working Group of the Digestive Endoscopy Branch of the Cross-Strait Medicine and Health Exchange Association organized 69 nationally recognized experts in 2025 to conduct extensive discussion and ultimately formulate the present Consensus.The aim is to standardize the application of sclerosing agent injection in the treatment of internal hemorrhoids.The Consensus is composed of 13 sections and addresses 19 clinical questions with corresponding recommendations.

Key words: Hemorrhoids, Internal hemorrhoids, Gastrointestinal endoscopy, Sclerotherapy injection, Consensus

Hemorrhoid Study Group of the Digestive Endoscopy Branch, Cross-Straits Medicine Exchange Association, Beijing 100010, China. Expert consensus on endoscopic sclerotherapy injection for internal hemorrhoids (2025, Guangzhou)[J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2025, 12(04): 225-240.

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分度(Grade)	描述
Ⅰ度	明显的血管充血，但不脱垂
Ⅱ度	痔在用力时从肛门脱垂，但可自行还纳
Ⅲ度	痔在用力时从肛门脱垂，不能自行还纳，需要人工还纳
Ⅳ度	痔持续脱垂，不能复位，出现慢性炎症改变，黏膜萎缩溃疡易见

分度(Grade)	描述
Ⅰ度	明显的血管充血，但不脱垂
Ⅱ度	痔在用力时从肛门脱垂，但可自行还纳
Ⅲ度	痔在用力时从肛门脱垂，不能自行还纳，需要人工还纳
Ⅳ度	痔持续脱垂，不能复位，出现慢性炎症改变，黏膜萎缩溃疡易见

解剖特点	痔核直径	风险因素
Lr：位于直肠	D：痔核直径	RF0：红色征阴性
		RF1：红色征阳性，无糜烂、血栓、活动性出血
		RF2：表面黏膜有糜烂、血栓、活动性出血

解剖特点	痔核直径	风险因素
Lr：位于直肠	D：痔核直径	RF0：红色征阴性
		RF1：红色征阳性，无糜烂、血栓、活动性出血
		RF2：表面黏膜有糜烂、血栓、活动性出血

内痔表现	级别	特征描述
内痔脱垂分级(P0、P1、P2、P3)	0	痔核肥大，无脱出
	1	排便时脱出肛门，便后自行还纳
	2	便后不能自行还纳，需要手指辅助还纳
	3	痔核持续脱出于肛门外，不能还纳
内痔出血频率(B0、B1、B2、B3)	0	不出血：近6个月内未发生便血
	1	较少出血：近6个月内发生1次以上便血
	2	经常出血：近1个月内发生1次以上便血
	3	反复出血：近1周内发生1次以上便血
表面黏膜风险(R0、R1、R2、R3)	0	无红色征、糜烂、溃疡、血栓和出血
	1	有红色征，无糜烂、溃疡、血栓和出血
	2	有糜烂、溃疡和血栓，无出血
	3	有糜烂、溃疡和血栓伴活动性出血

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