Endoscopic rubber band ligation, injection sclerotherapy, and sclerobanding for the treatment of internal hemorrhoids.

BACKGROUND

The clinical outcomes of endoscopic rubber band ligation (ERBL), injection sclerotherapy (IS), and endoscopic polidocanol sclerobanding (ESB) have not yet been well studied.

AIM: To evaluate the efficacy and safety of ERBL, IS, and ESB for treating grade I-III internal hemorrhoids.

METHODS

This retrospective cohort study was performed on 201 patients, who were grouped according to their endoscopic treatment (ERBL, IS, and ESB groups). Postoperative follow-ups were initially carried out at 1, 3, and 6 months, and then every 6 months, with the longest follow-up extending to 24 months. The study analyzed clinical efficacy, short-term and overall recurrence rates, and postoperative adverse events. Additionally, subgroup analysis was conducted based on the internal hemorrhoid grade (I or II-III).

RESULTS

The patient distribution across the ERBL, IS, and ESB groups was 70, 66, and 65, respectively. Both the ERBL and ESB groups demonstrated lower overall recurrence rates compared with the IS group (post-hoc analysis, P' = 0.024 and P' = 0.015, respectively). Subgroup analysis revealed that sclerotherapy resulted in a higher total recurrence rate than that achieved by sclerobanding (45.95% vs 19.57%, P' = 0.03), specifically for grade II-III internal hemorrhoids. No significant difference was found in grade I hemorrhoids. The ERBL group exhibited a higher incidence of postoperative pain, a worse median visual analog scale score, and a longer median duration of pain compared with those reported by the other groups (P < 0.001). This trend was consistent for grade II-III hemorrhoids. No significant differences were found among the three groups regarding clinical efficacy or recurrence rates within 6 months post-surgery, even when examined by subgroup.

CONCLUSION

The three treatments evaluated (ERBL, IS, and ESB) provide durable clinical outcomes for grade I hemorrhoids, with no significant differences in postoperative adverse events. For grade II-III hemorrhoids, ESB possesses the dual advantages of lower recurrence rates and reduced postoperative pain compared with IS and ERBL.