Flexible endoscopic treatment of internal hemorrhoids with versus without intravenous anesthesia: a retrospective study of 559 cases.

BACKGROUND

Flexible endoscopic therapies are effective for grade II-III internal hemorrhoids; however, the impact of intravenous anesthesia on clinical outcomes remains uncertain. This study compared the efficacy, safety, and cost-effectiveness of endoscopic treatment performed with versus without anesthesia.

METHODS

We retrospectively analyzed 559 patients who underwent endoscopic rubber band ligation (ERBL) or polidocanol foam sclerotherapy (EPFS) from May 2023 to November 2024. Patients were stratified by anesthesia modality (intravenous propofol vs. no anesthesia). Primary outcomes included procedure time, retreatment rate, symptom improvement, postoperative discomfort, patient satisfaction, total cost, and cost acceptance. Subgroup analysis was performed for EPFS cases.

RESULTS

Baseline characteristics were similar between groups. The anesthesia group had shorter procedure times (median 10.5 vs. 11.3 min, P = 0.036) and a lower retreatment rate (1.3% vs. 6.2%, P = 0.003). Rates of symptom improvement (83.1% vs. 82.7%, P = 0.940), postoperative discomfort, and patient satisfaction were comparable. Although the total treatment cost was higher in the anesthesia group (CNY 2,140.6 vs. 1,732.7, P < 0.001), cost acceptance remained high in both groups (85.8% vs. 91.4%, P = 0.173). Subgroup analysis of EPFS cases yielded consistent findings.

CONCLUSIONS

Flexible endoscopic treatment for internal hemorrhoids is safe and effective regardless of anesthesia use. Intravenous anesthesia improves procedural efficiency and reduces retreatment rates without compromising symptom relief or satisfaction. These findings support individualized anesthesia strategies tailored to patient preferences and institutional resources.