<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2341-4545</journal-id>
<journal-title><![CDATA[GE-Portuguese Journal of Gastroenterology]]></journal-title>
<abbrev-journal-title><![CDATA[GE Port J Gastroenterol]]></abbrev-journal-title>
<issn>2341-4545</issn>
<publisher>
<publisher-name><![CDATA[Sociedade Portuguesa de Gastrenterologia]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2341-45452025000200004</article-id>
<article-id pub-id-type="doi">10.1159/000540702</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Treatment of Hemorrhoidal Disease in Patients with Liver Cirrhosis: A Systematic Review]]></article-title>
<article-title xml:lang="pt"><![CDATA[Tratamento de Doença Hemorroidária em Doentes com Cirrose Hepática: uma Revisão Sistemática]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ponte]]></surname>
<given-names><![CDATA[So&#64257;a Bizarro]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Oliveira]]></surname>
<given-names><![CDATA[Joana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rei]]></surname>
<given-names><![CDATA[Andreia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Salgueiro]]></surname>
<given-names><![CDATA[Paulo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Unidade Local de Saúde de Santo António Department of Gastroenterology ]]></institution>
<addr-line><![CDATA[Porto ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidade do Porto Instituto de Ciências Biomédicas Abel Salazar ]]></institution>
<addr-line><![CDATA[Porto ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>04</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>04</month>
<year>2025</year>
</pub-date>
<volume>32</volume>
<numero>2</numero>
<fpage>4</fpage>
<lpage>16</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S2341-45452025000200004&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S2341-45452025000200004&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S2341-45452025000200004&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction:  The incidence of hemorrhoidal disease (HD) in cirrhotic patients is similar to that of general population, varying between 21% and 79%. Managing this clinical condition in these patients is challenging, due to the need to differentiate between bleeding originating from hemorrhoids or anorectal varices, and the unique hemostatic balance of each patient, which can lead to a decompensation of liver function and subsequently increase the anesthetic risk. To date, there are no systematic reviews speci&#64257;cally addressing this topic.  Methods:  This was a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were retrieved from three electronic databases. Ef&#64257;cacy (symptomatic improvement, patient satisfaction, quality of life improvement, disease recurrence/need for surgery and/or hemorrhoidal prolapse reduction in anoscopy) and safety (reported adverse events) outcomes were evaluated. Data from each study were initially described individually, followed by a comparative analysis for procedures applied in multiple studies. Results: Six studies were included - 1 randomized clinical trial (RCT), 2 prospective cohort studies, 1 retrospective cohort study, and 2 case series. The considered techniques encompassed rubber band ligation (RBL), injection sclerotherapy (IS) using 3 agents - aluminum potassium sulfate and tannic acid (ALTA), ethanolamine oleate 5% (EAO), or N-butyl-cyano-acrylate, hemorrhoidopexy, and emborrhoid technique. RBL showed great symptomatic improvement and patient satisfaction in 63% and 73% of patients, respectively, and in 90% was associated with one-grade prolapse reduction after only one session. The most frequently reported adverse events included pain (16%) and ulceration/&#64257;ssure (1-17%). Concerning IS, symptomatic improvement was observed in all patients. Recurrence rates varied with the agent used (EAO: 13% at 12 months; N-butyl-cyanoacrylate: 40% at 12 months; ALTA: 18% at 5 years), and 86.7% of patients exhibited more than one-grade reduction after the initial session. The most frequent adverse event was pain (EAO: 63%; N-butyl-cyanoacrylate: 60%). Stapled hemorrhoidopexy resulted in symptomatic improvement in all patients, although associated with a recurrence rate of 25%within 4 months. With an emborrhoid technique, 80% of the patients showed clinical improvement at a 3-month follow-up, without signi&#64257;cant adverse events, at the cost of a 40%recurrence rate.  Conclusions:  All the treatment methods assessed in the included studies appear to be effective and safe in cirrhotic patients. This assumption challenges pre-vious concerns regarding signi&#64257;cant bleeding after of&#64257;ce-based procedures like RBL in this population. Future research should prioritize RCT to thoroughly assess the management of HD in these patients, particularly addressing polidocanol foam sclerotherapy, a minimally invasive technique that has previously been shown to be more ef-fective than RBL in the general population and in patients with bleeding disorders.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo  Introdução:  A incidência da doença hemorroidária em doentes cirróticos é semelhante à da população geral, variando entre 21% e 79%. A abordagem desta patologia nestes doentes constitui um desa&#64257;o, dada a necessidade de distinguir entre hemorragia hemorroidária ou por rotura de varizes anorretais e o balanço hemostático singular dos doentes cirróticos, que pode acarretar um maior risco anestésico.  Métodos:  Revisão sistemática de acordo com Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Os artigos foram selecionados de 3 bases de dados eletrónicas. Foram avaliados parâmetros de e&#64257;cácia (melhoria sintomática, satisfação do doente, melhoria na qualidade de vida, recorrência da doença/necessidade de cirurgia e/ou redução do prolapso hemorroidário na anuscopia) e segurança (complicações). Os resultados de cada estudo foram descritos individualmente e, sempre que possível, foi posteriormente realizada uma análise comparativa.  Resultados:  Seis estudos foram incluídos - 1 ensaio clínico randomizado, 2 estudos de coorte prospetivos, 1 estudo de coorte retrospetivo e 2 séries de casos. As técnicas estudadas incluíram laqueação elástica, escler-oterapia com 3 agentes esclerosantes - sulfato de alumínio e potássio e ácido tânico (ALTA), oleato de etanolamina a 5% (EAO) ou N-butil cianoacrilato, hemorroidopexia e embolização. A laqueação elástica demonstrou grande melhoria sintomática e taxa de satisfação em 63% e 73% dos doentes (respetivamente) e associou-se a uma redução de pelo menos 1 grau no prolapso após a primeira sessão em 90%. As complicações mais comuns foram a dor (16%) e ulceração/&#64257;ssura (1-17%). A escleroterapia provocou uma melhoria sintomática em 100% dos doentes. As taxas de recorrência variaram com o agente (EAO: 13% aos 12 meses; N-butil-cianoacrilato: 40% aos 12 meses; ALTA: 18% aos 5 anos), e 86.7% dos doentes apresentaram uma redução de pelo menos 1 grau no prolapso após a primeira sessão. O evento adverso mais frequente foi a dor (EAO: 63%; N-butil-cianoacrilato: 60%). A hemorroidopexia demonstrou melhoria sintomática em 100% dos doentes, contudo, com uma recorrência de 25% em 4 meses. Com a embolização hemorroidária, 80% dos pacientes mos-traram melhoria clínica aos 3 meses, sem registo de eventos adversos major, mas associada a uma taxa de recorrência de 40%.  Conclusão:  Todas as técnicas avaliadas parecem ser e&#64257;cazes e seguras nos doentes cirróticos. Esta premissa vem desa&#64257;ar o pressuposto de um elevado risco hemorrágico associado aos procedimentos terapêuticos na doença hemorroidária nesta população. Investigações futuras devem priorizar ensaios clínicos randomizados, que incluam técnicas minimamente invasivas, nomeadamente a escleroterapia com polidocanol espumoso, que já demonstrou ser mais e&#64257;caz do que a laqueação elástica na população geral e em doentes com distúrbios de coagulação.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Hemorrhoidal disease]]></kwd>
<kwd lng="en"><![CDATA[Liver cirrhosis]]></kwd>
<kwd lng="en"><![CDATA[Systematic review]]></kwd>
<kwd lng="pt"><![CDATA[Doença hemorroidária]]></kwd>
<kwd lng="pt"><![CDATA[Cirrose hepática]]></kwd>
<kwd lng="pt"><![CDATA[Revisão sistemática]]></kwd>
</kwd-group>
</article-meta>
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