Specialist commentator comments

Comments on this technology were invited from clinical specialists working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

Three specialists were familiar with this technology but none had used it before.

Level of innovation

The 3 specialists noted that eXroid was a new technology that had not been superseded. The specialists did note that there are other techniques available that are less invasive than stapling and excision, including electrotherapy and electrofrequency ablation, transanal haemorrhoidal dearterialisation and haemorrhoid artery ligation operation. Two specialists pointed out that eXroid is similar to other radiofrequency ablation techniques but noted that these may need light sedation.

Potential patient impact

The 3 specialists stated that eXroid could offer advantages to patients because it is a quick procedure, which is well tolerated and does not need any anaesthetic (even local). One specialist noted that eXroid could offer particular benefits to patients who cannot have general anaesthetic or have extensive comorbidities. Another specialist noted that eXroid is more likely to be effective for grade 1 and 2 haemorrhoids than in grade 3 haemorrhoids. All 3 experts stated that more longer-term evidence would be needed to see the long-term efficacy of using eXroid compared with current standard treatments.

Potential system impact

All experts agreed that further evidence is needed to determine the long-term efficacy of eXroid, particularly the average number of treatments needed. Two experts advised that if eXroid can treat haemorrhoids in a single application, then it is likely to be resource releasing. If using eXroid needs more than 1 application or appointment, it is likely to be cost incurring.

One specialist thought that treatment with eXroid could be done by a properly trained non-medically qualified healthcare professional. Another noted that it might be used by GPs who had training and have an assistant available. The third expert stated that the procedure should be done by a specialist and did not think that GPs or nurse practitioners would be able to do treatments with eXroid.

One specialist noted that using eXroid could take longer than other treatments for haemorrhoids, particularly if a patient has multiple haemorrhoids or needs repeat treatments. They noted that this would have a detrimental effect on already stretched services. Another specialist noted that using eXroid may lead to an increase in people seeking treatment for haemorrhoids, particularly if it is viewed as a painless outpatient procedure.

All specialists agreed that anyone using eXroid would need proper training.

General comments

One specialist noted that during treatment with eXroid, because the patient is awake, they will need to stay still in the left lateral position for 45 minutes. They noted that this may be challenging for many patients.

All specialists agreed that further evidence is needed for eXroid, particularly in comparison with other treatments such as banding, haemorrhoid artery ligation operation and radiofrequency ablation.