Endoscopic score predicting recurrence after foam sclerotherapy in grade I internal hemorrhoids: Development and external validation

Figure 1 Patients with Goligher grade I internal hemorrhoids receiving foam sclerotherapy were evaluated using standardized clinical and endoscopic features. Endoscopic Hemorrhoid Recurrence Score was developed and externally evaluated, with exploratory endoscopic and histopathological biological verification. The score provides recurrence-risk stratification and may inform the design of future risk-adapted follow-up studies. Endo-HRS: Endoscopic Hemorrhoid Recurrence Score.

Figure 2 Study cohort flowchart. A: Development cohort; B: External validation cohort.

Figure 3 Forest plot of variables in the prediction model. HR: Hazard ratio; CI: Confidence interval.

Figure 4 Model performance and clinical application of Endoscopic Hemorrhoid Recurrence Score. A: Time-dependent receiver operating characteristic curve for 36-month recurrence. The bronze, green, and blue points represent the rule-in, Youden-optimized, and rule-out thresholds, respectively. The Youden threshold (22.8) is a binary reference, whereas the lower and upper thresholds define the three-tier groups; B: Kaplan-Meier recurrence-free interval curves for groups A, B, and C; C: Nomogram estimating individual 36-month recurrence probability. ROC: Receiver operating characteristic; Endo-HRS: Endoscopic Hemorrhoid Recurrence Score.

Figure 5 External validation of the Endoscopic Hemorrhoid Recurrence Score model. A: Time-dependent receiver operating characteristic curves for recurrence prediction at 24 (bronze), 36 (green), and 48 (blue) months; B: Kaplan-Meier recurrence-free interval curves for Endoscopic Hemorrhoid Recurrence Score groups A (blue), B (green), and C (bronze). AUC: Area under the curve; Endo-HRS: Endoscopic Hemorrhoid Recurrence Score.

Figure 6 Exploratory multimodal biological verification of Endoscopic Hemorrhoid Recurrence Score. A-C: Endoscopic images from groups A, B, and C, respectively (black arrows: Hemorrhoids; white arrows: Red color signs); D-F: Representative hematoxylin-eosin sections (20 ×; scale bar = 50 μm; black triangles: Enlarged vessels); G-I: Representative Masson’s trichrome sections (20 ×; scale bar = 50 μm). These images provide exploratory biological context and do not constitute independent predictive validation.