Preparation of the polidocanol foam according to Tessari technique immediately before application (so that the "microbubbles" of the foam did not disintegrate);
Application according to the Blanchard technique (Fig. 2) through a disposable transparent anoscope, with the patient in jackknife position, using a 20mL disposable syringe of the mixture (polidocanol + air) and a reusable 10 cm syringe extender adapted to an intravenous needle;
Patients treated in a maximum of 3 sessions at 3 weeks intervals;
Maximum dose per treatment session of 20mL of mixture of 4mL of polidocanol 3% with 16mL of air;
In each session more than one hemorrhoid cushion could be treated.

Use of reusable metal ligation device connected to a vacuum system (McGown suction method) to apply the rubber bands above the dentated line through a disposable transparent anoscope with the patient in jackknife position;
A maximum of 3 sessions of ligation at 3-week intervals were performed;
More than 1 band per session could be applied.

Hemorrhoids, Internal

Two distinct periods were considered: intervention and follow-up. During the intervention period patients were observed at 3-week intervals (minimum of 3 weeks and maximum of 9 weeks depending on the number of instrumental treatments performed). The required number of sessions of any of the office-based treatments (maximum of 3 sessions) was determined by clinical and anoscopy response (if after the treatment the participant scored zero points in the Sodergren scale or the anoscopy did not reveal significant hemorrhoidal disease, there was no place for additional instrumental therapy and the patient started the follow-up period.
If there was therapeutic failure at the end of the third session or if there was a significant complication (moderate or severe) the patient's participation in the study ended and he was referred for treatment with other type of office-based procedure or surgery.

Polidocanol Injectable Foam

Rubber band ligation

Centro Hospitalar Universitário do Porto

Polidocanol Foam Versus Rubber Band Ligation in the Treatment of Hemorrhoidal Disease

Sclerotherapy With Polidocanol Foam Versus Rubber Band Ligation in the Treatment of First, Second and Third-Grade Hemorrhoidal Disease: a Randomized, Controlled Trial

Achievement of therapeutic success. Classified as:
Complete (Sodergren score = 0 and bleeding grade ≤ 1);
Partial (Sodergren score> 0 and bleeding grade > 1 but with improvement over initial score);
Therapeutic failure (participants that, at the end of three sessions of instrumental treatment, aggravated or maintained the initial Sodergren score and bleeding grade).

Recurrence of hemorrhoidal disease during the follow-up period (only for patients who have had some degree of therapeutic success). Classified as:
Mild (Sodergren score and bleeding grade higher than the evaluation at the beginning of the follow-up period but lower than the initial ones without the need for instrumental or surgical intervention);
Severe (Sodergren score and degree of hemorrhage ≥ the initial one requiring instrumental or surgical intervention).

Complications resulting from the office-based procedures are recorded and classified as:
Mild (e.g. pain/discomfort; pruritus; bright red blood on toilet paper/cleaning pad, hemorrhoidal thrombosis requiring only medical treatment);
Moderate (e.g. external hemorrhoidal thrombosis requiring surgical intervention; bright red blood that drips in the toilet or clot expulsion not requiring blood transfusion, urgent hemostasis or urgent surgery): obliges the participant to be withdrawn from the study but do not endanger the patient's life or leave long term sequelae;
Severe (e.g. sepsis; Fournier's gangrene; perineal abscess; bleeding with hemodynamic instability, transfusional need or urgent surgery; sexual impotence in man): obliges the participant to be withdrawn from the study and put the patient's life at risk or implies long-term sequelae.

Number of instrumental treatment sessions required to achieve therapeutic success.

Evolution of the grade of hemorrhoidal disease (Goligher's classification).

Paulo Sérgio Durão Salgueiro

Principal Investigator

Universidade do Porto

Participants will be randomly assigned to either rubber band ligation or sclerotherapy with polidocanol foam, stratified by grade of hemorrhoidal disease

this arm will recieve PEG3350 in addition to standard of care

this arm will recieve only standard of care for management of hepatic encephlaopathy with ACLF

Hepatic Encephalopathy

Acute-On-Chronic Liver Failure

experimental arm will receive 2 doses of PEG3350 spaced over 12 hours after randomization to arm1. PEG as dose of 2litres (1 sachet dissolved in 2L of water) will be administered via a nasogastric tube.

PEG-3350 with Electolytes

Lactulose will be given orally (30ml QID) which shall be titrated to ensure 2-3 soft stools per day

Lactulose

Postgraduate Institute of Medical Education and Research

PEG3350 in ACLF With Hepatic Encephalopathy

Therapeutic Efficacy of Oral PEG3350 Plus Lactulose Versus Lactulose Alone in Patients of Acute on Chronic Liver Failure With Overt Hepatic Encephalopathy: A Single Blind Prospective Randomized Controlled Study

to look for any survival benefit in experimental arm at 28 days and 90 days

to look for the degree of improvement in grade of HE in both experimental arm and lactulose arm.

to extrapolate weather reduction of grade of HE correlates with reduction of ammonia levels

to analyse the difference in time to event(death) among non survivors in experimental arm

to look for any evidence of cerebral edema reduction by means of optic nerve sheath diameter

to analyse if reduction of HEresults in reduction or prevention of seizure episodes in both arms

Radha K Dhiman

Professor

participant is randomised using a table of random numbers.

Dyspeptic subjects who visited for evaluation and agreed on 16S rRNA pyrosequencing analysis

Microbial Colonization

Gastritis

Next generation sequencing analysis will be done for 16S rRNA V1,2 hypervariable regions at Biocore (Seoul, Korea).

16S rRNA pyrosequencing analysis

Konkuk University Medical Center

Gastric and Duodenal Microbiota in Dyspeptic Subjects

Composition of Gastric and Duodenal Microbiota in Dyspeptic Subjects

16S rRNA pyrosequencing analysis findings of the gastric and duodenal biopsies

0=none, 1=mild, 2= moderate, 3=marked infiltration

Upper gastrointestinal endoscopy findings

Scoring system published in Neurogastroenterol Motil 2016;28:1401-1408

laxative/atrofija

Polidocanol Foam Versus Rubber Band Ligation in the Treatment of Hemorrhoidal Disease

PEG3350 in ACLF With Hepatic Encephalopathy

Gastric and Duodenal Microbiota in Dyspeptic Subjects

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