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Hemorrhoidal disease (HD) is a prevalent proctological condition that has puzzled people since ancient times, and the most common symptom is painless bleeding. Traditional treatments include conservative treatment, nonsurgical office-based treatments, and surgery. Sclerotherapy is one of the oldest forms of nonoperative intervention and is widely used to treat internal hemorrhoids with the development of endoscopy technology. However, sclerotherapy is always accompanied by complications such as bleeding, pain, abscess, etc., when the sclerosant is injected into the wrong site. Cap-assisted endoscopic sclerotherapy (CAES), a new minimally invasive technology, was first time coined in 2015 for the treatment of hemorrhoidal disease. The left-posterior–right-anterior (LPRA) anus positioning method under endoscopy provides reliable methodological support for advancing hemorrhoidal treatment via endoscopy. The current trend is that treatment for HD has shifted from being performed predominantly by the Department of Proctology Surgery to being managed mostly by the Department of Gastroenterology. This review reviewed the shifting paradigms of sclerotherapy for HD and discussed the emerging development of CAES. [ABSTRACT FROM AUTHOR]

Hemorrhoidal disease is common. External hemorrhoidal thrombosis is its main painful manifestation; its treatment is most often medical. Bleeding and limited prolapse can be treated with infrared coagulation or rubber band ligations. In case of failure, grade 4 prolapse or anemia of hemorrhoidal origin, surgery is indicated. Pedicular hemorrhoidectomy remains the most effective treatment. [ABSTRACT FROM AUTHOR]

Background: The symptoms of hemorrhoids has a wide spectrum that ranges from bleeding per rectum, itching, prolapse of the hemorrhoidal cushions, thrombosis leading to pain and discomfort, incontinence especially of fluids and mucous discharge. But for surgical management, hemorrhoidectomy is more sustainable in symptom control and has been considered as gold standard. Rubber band ligation has been the most popular amongst non-surgical interventions because of its effectiveness, minimal complication rate and shorter recover period compared to operative procedures. The present study aimed at determining the efficacy and safety of rubber banding ligation procedure versus the standard hemorrhoidectomy for second degree hemorrhoids. Methods: A prospective randomised comparative study was conducted at Department of Surgery, Indira Gandhi Medical College Hospital, Puducherry for 18 months after getting institutional ethical committee clearance. A total no. of 74 cases of 2nd degree hemorrhoids were divided into two groups A (open hemorrhoidectomy) and B (banding) by simple randomization technique of 37 each. A detailed history & examination including per rectal and Proctoscopy examination was done of each patient and the data entered in the pro forma. The description of data was expressed in the form of mean±SD for quantitative data, while frequency and proportion for qualitative data. Results: Totally male patients represented 57% compared to female with 43% 78% of the patients who underwent banding did not have any immediate post-operative complications while only 4 persons reported pain and bleeding post-operatively compared to 12 patients reporting bleeding and 11 patients reporting pain after hemorrhoidectomy. The duration of hospital stay post procedures was found to be lesser in banding group compared to hemorrhoidectomy group with p value being statistically highly significant (p

Abstract Purpose As a minimally invasive procedure, laser hemorrhoidoplasty (LHP) can not only relieve the symptoms of hemorrhoids, but also protect the anal cushion structure. This study aimed to investigate the clinical efficacy of LHP in the treatment of grade II hemorrhoids. Methods A total of 70 patients with grade II hemorrhoids were randomly assigned to receive LHP or Rubber Band Ligation (RBL) (n = 35 per group) in 2019 from a single center. The postoperative pain, bleeding, feeling of anal distension(local falling, swelling, foreign body sensation, stool) and postoperative recurrence rate were compared between the two groups. Results The postoperative pain, bleeding, and feeling of anal distension in the LHP group were improved significantly as compared with the RBL group within 2 weeks after surgery (P 0.05). The patients in LHP group took less time to return to normal activities (P

Purpose: As a minimally invasive procedure, laser hemorrhoidoplasty (LHP) can not only relieve the symptoms of hemorrhoids, but also protect the anal cushion structure. This study aimed to investigate the clinical efficacy of LHP in the treatment of grade II hemorrhoids. Methods: A total of 70 patients with grade II hemorrhoids were randomly assigned to receive LHP or Rubber Band Ligation (RBL) (n = 35 per group) in 2019 from a single center. The postoperative pain, bleeding, feeling of anal distension(local falling, swelling, foreign body sensation, stool) and postoperative recurrence rate were compared between the two groups. Results: The postoperative pain, bleeding, and feeling of anal distension in the LHP group were improved significantly as compared with the RBL group within 2 weeks after surgery (P < 0.01). Both methods can relieve the symptoms of grade II hemorrhoids. There was no difference in the recurrence rate between the two groups at 1 year after surgery (P > 0.05). The patients in LHP group took less time to return to normal activities (P < 0.001). Conclusions: As a minimally invasive treatment, LHP is easy and not traumatic and results in mild postoperative pain and few complications. It is an ideal choice for grade II hemorrhoids. [ABSTRACT FROM AUTHOR]

Introduction and purpose Hemorrhoidal disease is one of the most common proctological problems worldwide. The etiology of hemorrhoidal disease has not been fully explained. Authors note that lifestyle factors and dietary habits are primarily responsible for hemorrhoidal disease. These include: a low-fiber diet, constipation, a sedentary lifestyle, and suboptimal body position during defecation commonly observed in Western societies. Due to the high prevalence of the disease in the population and the associated decrease in quality of life, outpatient procedural treatments that are highly effective and allow for a quick return to normal activity are very popular among patients. The aim of this study is to discuss non-surgical methods of hemorrhoid treatment. Material and methods This paper was based on a review of materials available on PubMed, searched using the following keywords: “hemorrhoids”, “sclerotherapy”, “rubber band ligation”, „infrared coagulation”, „laser hemorrhoidoplasty”, „Doppler guides hemorrhoidal artery ligation”. Results In recent years, there has been a significant development in non-surgical techniques for treating hemorrhoids, which are widely used in patients with grade I-III hemorrhoids and can be performed in an outpatient setting or during short hospital stays with the use of regional anesthesia, such as: Sclerotherapy, rubber band ligation, Infrared coagulation, Laser hemorrhoidoplasty, Doppler Guides Hemorrhoidal Artery Ligation. Conclusion In conclusion, non-surgical methods for the treatment of hemorrhoids offer a range of effective alternatives to conventional surgery. The choice of treatment should be individualized, taking into account the severity of the hemorrhoidal disease, patient preferences, and the potential for complications.

Abstract Introduction Haemorrhoidal disease (HD) is a common condition with significant epidemiologic and economic implications. While it is possible to treat symptomatic grade 1–2 haemorrhoids with rubber band ligation (RBL) or sclerotherapy (SCL), the effectiveness of these treatments compatible with current standards has not yet been investigated with a randomised controlled trial. The hypothesis is that SCL is not inferior to RBL in terms of symptom reduction (patient-related outcome measures (PROMs)), patient experience, complications or recurrence rate. Methods and analysis This protocol describes the methodology of a non-inferiority, multicentre, randomised controlled trial comparing rubber band ligation and sclerotherapy for symptomatic grade 1–2 haemorrhoids in adults (> 18 years). Patients are preferably randomised between the two treatment arms. However, patients with a strong preference for one of the treatments and refuse randomisation are eligible for the registration arm. Patients either receive 4 cc Aethoxysklerol 3% SCL or 3 × RBL. The primary outcome measures are symptom reduction by means of PROMs, recurrence and complication rates. Secondary outcome measures are patient experience, number of treatments and days of sick leave from work. Data are collected at 4 different time points. Discussion The THROS trial is the first large multicentre randomised trial to study the difference in effectivity between RBL and SCL for the treatment of grade 1–2 HD. It will provide information as to which treatment method (RBL or SCL) is the most effective, gives fewer complications and is experienced by the patient as the best option. Ethics and dissemination The study protocol has been approved by the Medical Ethics Review Committee of the Amsterdam University Medical Centers, location AMC (nr. 2020_053). The gathered data and results will be submitted for publication in peer-reviewed journals and spread to coloproctological associations and guidelines. Trial registration Dutch Trial Register NL8377 . Registered on 12–02-2020.

Introduction Rubber band ligation is a minimally invasive outpatient hemorrhoid treatment with low cost, low complication rates, and rapid realization. It is performed with the aid of an anoscope and uses a rubber ring that surrounds the hemorrhoidal nipple, causing compression of the vascular structures of the tissue, leading to necrosis and remission of the hemorrhoid. No device for training this essential procedure for treating this pathology has been identified in the literature. Therefore, we aim to develop a low-cost simulator for training hemorrhoidal rubber ligation.

Background: Rubber band ligation (RBL) is a widely accepted intervention for the treatment of haemorrhoids. However, post procedure pain is a common complaint. The aim of this study was to determine whether the addition of local anaesthetic (LA) to the haemorrhoid pedicle base, post RBL, aids in reducing early post-procedure pain. Additionally, to compare perceived perianal numbness, oral analgesia usage and total consumption, and adverse events. Methods: This study was a prospective, single-blinded randomised controlled trial. Patients were recruited from colorectal clinics in two Australian hospitals between 2018–2019. Patients randomised to the intervention (LA) group received 2mls bupivacaine 0.5% with adrenaline 1:200,000 to each haemorrhoid base. Patients in the control group were not administered LA. Pain scores were recorded over 48 h using visual analogue scales. Analgesia consumption was documented and other secondary objectives were recorded dichotomously (yes/no). Results: At 1 h post-procedure, patient reported pain scores were significantly lower in the LA group compared to the control group (p = 0.04). There were no significant differences in pain scores between the groups at 4, 24 or 48 h. Additionally, there were no significant differences between groups with respect to oral analgesia usage, perianal numbness or adverse events. Conclusions: LA to the haemorrhoid pedicle post RBL may significantly reduce early post procedure pain without any increased risk of adverse effects. [ABSTRACT FROM AUTHOR]

Background: Endoscopic rubber band ligation (ERBL) is considered an effective nonsurgical treatment for symptomatic grade I to III hemorrhoids; however, it is unclear whether ligation of hemorrhoids or simultaneous ligation of hemorrhoids and proximal normal mucosa (combined ligation) is safer and more effective. This controlled, open-label, and prospective study aimed to evaluate the efficacy and safety of both methods for symptomatic grade I to III hemorrhoids. Methods: Seventy patients with symptomatic grade I to III hemorrhoids were randomly assigned to the hemorrhoid and combined ligation groups (35 in each group). Patients were followed up at 3, 6, and 12 months to assess symptom improvement, complications, and recurrence. The primary outcome was overall therapeutic success rate (complete resolution and partial resolution rates). The secondary outcomes included recurrence rate and efficacy for each symptom. Complications and patient satisfaction were also assessed. Results: Sixty-two patients (31 in each group) completed the 12-month follow-up; 42 (67.8%) experienced complete resolution, 17 (27.4%) experienced partial resolution, and 3 (4.8%) experienced no change in overall efficacy. The rates of complete resolution, partial resolution, and no change in the hemorrhoid ligation and combined ligation groups were 71.0 and 64.5%, 22.6 and 32.3%, and 6.5 and 3.2%, respectively. No significant differences in overall efficacy, recurrence rate, or efficacy for each symptom (including bleeding, prolapse, pain, anal swelling, itching, soiling, and constipation) were observed between groups. No life-threatening events requiring surgical intervention occurred. The incidence of postoperative pain was higher in the combined ligation group (74.2% vs. 45.2%, P = 0.02). No significant differences between groups in terms of incidences of other complications or patient satisfaction were observed. Conclusion: Both methods achieved satisfactory therapeutic effects. No significant differences in efficacy and safety of the two ligation methods were observed; however, combined ligation resulted in a higher incidence of postprocedural pain. [ABSTRACT FROM AUTHOR]

Purpose Rubber band ligation (RBL) for grade 1 to 3 internal hemorrhoids is a well-established modality of choice. But RBL is also a kind of surgical treatment; it is not free from complications (e.g., delayed bleeding [DB], rectal stenosis). This study aimed to investigate the results of the comparative treatment of RBL and BANANA-Clip (BC; Endovision). Methods Study participants were 632 consecutive patients with grade 1 to 3 internal hemorrhoids attended to Department of Colorectal Surgery at Wellness Hospital between January 2010 and May 2019. We retrospectively reviewed the incidence rate of complications, including DB between RBL and BC. Results There were 304 male and 328 female patients, whose ages ranged from 15 to 84 years, with a mean age of 45.7 years. The common symptom and cause of treatment was prolapse (70.1%). The number of ligated sites was 1.49±0.57 in the RBL group and 1.99±0.77 in the BC group. RBL showed a significantly higher incidence of DB (3.5%) compared to BC (0%) (P=0.001). The 1-year success rate was 95.9% in the RBL group and 99.7% in the BC group (P=0.005). Conclusion In our study, BC was more reliable in treating grade 1 to 3 internal hemorrhoids with higher success rates and less postligation complications, especially DB, compared to RBL.

Introduction: Haemorrhoidal disease (HD) is a common condition with significant epidemiologic and economic implications. While it is possible to treat symptomatic grade 1–2 haemorrhoids with rubber band ligation (RBL) or sclerotherapy (SCL), the effectiveness of these treatments compatible with current standards has not yet been investigated with a randomised controlled trial. The hypothesis is that SCL is not inferior to RBL in terms of symptom reduction (patient-related outcome measures (PROMs)), patient experience, complications or recurrence rate. Methods and analysis: This protocol describes the methodology of a non-inferiority, multicentre, randomised controlled trial comparing rubber band ligation and sclerotherapy for symptomatic grade 1–2 haemorrhoids in adults (> 18 years). Patients are preferably randomised between the two treatment arms. However, patients with a strong preference for one of the treatments and refuse randomisation are eligible for the registration arm. Patients either receive 4 cc Aethoxysklerol 3% SCL or 3 × RBL. The primary outcome measures are symptom reduction by means of PROMs, recurrence and complication rates. Secondary outcome measures are patient experience, number of treatments and days of sick leave from work. Data are collected at 4 different time points. Discussion: The THROS trial is the first large multicentre randomised trial to study the difference in effectivity between RBL and SCL for the treatment of grade 1–2 HD. It will provide information as to which treatment method (RBL or SCL) is the most effective, gives fewer complications and is experienced by the patient as the best option. Ethics and dissemination: The study protocol has been approved by the Medical Ethics Review Committee of the Amsterdam University Medical Centers, location AMC (nr. 2020_053). The gathered data and results will be submitted for publication in peer-reviewed journals and spread to coloproctological associations and guidelines. Trial registration: Dutch Trial Register NL8377. Registered on 12–02-2020. [ABSTRACT FROM AUTHOR]

Purpose: Symptomatic internal hemorrhoids affect up to 40% of people in Western society. Patients with grade I–III hemorrhoids, who fail lifestyle and medical management, may benefit from office-based procedures. As per the American Society of Colon and Rectum Surgeons (ASCRS), rubber band ligation (RBL) is the first-line office-based treatment. Polidocanol sclerotherapy is a relatively new approach for these patients. The aim of this systematic review is to compare the efficacy of RBL and polidocanol sclerotherapy with the treatment of symptomatic grade I–III internal hemorrhoids. Methods: The systematic review was completed by searching MEDLINE, Embase, and CENTRAL databases from inception to August 2022 for prospective studies comparing RBL and polidocanol sclerotherapy or evaluating the efficacy of polidocanol sclerotherapy alone for adult (> 18 years) patients with grade I–III internal hemorrhoids. Treatments were evaluated for therapeutic success and post-procedure morbidity. Results: Of 155 citations obtained, 10 studies (3 comparative and 7 single-arm studies) and 4 abstracts (2 comparative and 2 single arm) were included in the study. The patients undergoing sclerotherapy had a 93% (151/163) therapeutic success rate compared to 75% (68/91) in the RBL group (OR 3.39, 95% CI 1.48–7.74, p < 0.01). The post-procedure morbidity was 8% (17/200) in the sclerotherapy group and 18% (23/128) in the RBL group (OR 0.53, 95% CI 0.15–1.82, p = 0.31). Conclusion: This study highlights that polidocanol sclerotherapy may be associated with higher therapeutic success in patients with symptomatic grade I–III internal hemorrhoids. Further evaluations in the form of randomized trials are required to evaluate patient populations, which may benefit more from sclerotherapy. [ABSTRACT FROM AUTHOR]

Rubber band ligation is one of the most commonly performed office‑based procedures for internal hemorrhoids. Since there is no somatic sensation in the area above the dentate line, this region is a suitable location for banding. With proper technique, patients may still feel mild rectal pressure during the procedure (which may last up to 1–2 days) but should not experience pain. We present the case of a 34‑year‑old man presenting with symptomatic hemorrhoids unresponsive to medical treatment. Proctoscopy revealed grade I internal hemorrhoids. Rubber band ligation was performed on all three hemorrhoidal piles, and the patient was subsequently discharged. Four hours post‑procedure, the patient returned to the clinic with severe pain localized to the lower left leg, primarily in the shin and foot, accompanied by numbness and a pins‑and‑needles sensation. The patient’s pain was alleviated through the administration of local and oral analgesia without the necessity of band removal. [ABSTRACT FROM AUTHOR]

Purpose: The main objective of this study was to assess the impact on quality of life after rubber band ligation (RBL) in patients with symptomatic grade II-III haemorrhoids who did not improve after 6 months of conservative treatment, using quality of life scores. Methods: This was a prospective cohort observational study where patients with haemorrhoidal disease and indication for RBL were included between December 2019 and December 2020. RBL was offered as first-line treatment in this group. Patient´s quality of life was assessed by scores: HDSS (Hemorrhoidal Disease Symptom Score) and SHS (Short Health Scale).Secondary objectives were: to evaluate the rate of patients requiring one or more RBL procedures, to establish the overall success rate of RBL and to analyse complications. Results: A total of 100 patients were finally included. Regarding the impact on quality of life after RBL, a significant reduction was found in the HDSS and SHS scores (p < 0.001). The main improvement was found in the first month and it was maintained until the sixth month. A high degree of satisfaction with the procedure was reported by 76% of patients. The overall success rate of banding was 89%. A 12% complication rate was detected, the most frequent complication was severe anal pain (58.3%) and self-limiting bleeding (41.7%). Conclusion: Rubber band ligation, as a treatment for symptomatic grade II-III haemorrhoids that do not respond to medical treatment, leads to a significant improvement in patients' symptoms and quality of life. It also has a high degree of satisfaction between patients. [ABSTRACT FROM AUTHOR]

Abstract Background Massive, delayed bleeding (DB) is the most common major complication of Rubber Band Ligation (RBL) for internal hemorrhoids caused by premature band slippage. In this study we modified conventional RBL to prevent early rubber band slippage and evaluated its clinical efficacy and safety. Methods Study participants were consecutive patients with grade II or III internal hemorrhoids treated with RBL at Ningbo Medical Center of Lihuili Hospital from January 2019 to December 2020. Postoperative minor complications such as pain, swelling, anal edema, prolapse recurrence and major complications like DB were retrospectively reviewed. Results A total of 274 patients were enrolled, including 149 patients treated with modified RBL and 125 treated with conventional RBL. There was no statistically significant difference between the two groups at baseline. Five cases of postoperative DB have been observed in the conventional RBL group, compared to none in the modified ones, with a significant difference (P 0.05). Conclusion Modified RBL may be associated with a lower rate of complications, especially with lower DB rate in comparison with standard RBL. Further studies in larger samples and different design are necessary to confirm these results.

Purpose Standard therapy for grade III hemorrhoids is rubber band ligation (RBL) and hemorrhoidectomy. The long-term clinical and patient-reported outcomes of these treatments in a tertiary referral center for proctology were evaluated. Methods A retrospective analysis was performed in all patients with grade III hemorrhoids who were treated between January 2013 and August 2018. Medical history, symptoms, reinterventions, complications, and patient-reported outcome measurements (PROM) were retrieved from individual electronic patient files, which were prospectively entered as standard questionnaires in our clinic. Results Overall, 327 patients (163 males) were treated by either RBL (n=182) or hemorrhoidectomy (n=145). The median follow-up was 44 months. The severity of symptoms and patient preference led to the treatment of choice. The most commonly experienced symptoms were prolapse (83.2%) and blood loss (69.7%). Hemorrhoidectomy was effective in 95.9% of the cases as a single procedure, while a single RBL procedure was only effective in 51.6%. In the RBL group, 34.6% received a second RBL session. Complications were not significantly different, 11 (7.6%) after hemorrhoidectomy versus 6 (3.3%) after RBL. However, 4 fistulas developed after hemorrhoidectomy and none after RBL (P

Introduction: The most frequently used office-based procedures in hemorrhoidal disease (HD) are rubber band ligation (RBL) and sclerotherapy. Few studies have been published comparing the various types of instrumental therapy. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of sclerotherapy and RBL. Methods: Three online databases were searched. Efficacy (control of symptoms, prolapse, bleeding and pain, patients’ satisfaction, and disease recurrence) and safety (complications, such as pain and bleeding) were the assessed outcomes. Pooled relative risks (RR) were computed for each outcome using a random-effects model, and heterogeneity was assessed by Cochran’s Q test and I2. Results: Six RCTs and three cohort studies were included. Control of prolapse and bleeding was significantly higher with RBL (93.1% RBL vs. 66.4% sclerotherapy, RR 1.34, 95% CI 1.12–1.60 and 89.1% RBL vs. 78.7% SCL, RR 1.17, 95% CI 1.02–1.34, respectively). Both techniques had similar results in terms of pain relief, overall control of symptoms, and risk of recurrence at 3 months. Although patient satisfaction was significantly higher with RBL (77.8% RBL vs. 46.7% sclerotherapy, RR 1.59, 95% CI 1.01–2.50), post-procedural pain was significantly higher with this technique (24% RBL vs. 14% sclerotherapy, RR 1.74, 95% CI 1.32–2.28). There was no significant difference regarding post-procedure bleeding (11.1% RBL vs. 8.7% sclerotherapy, RR 1.29, 95% CI 0.86–1.94). In the subgroup analysis, according to the HD grade, post-procedure pain was higher with RBL only in HD grade II (vs. HD grade I–III). Conclusions: RBL performs better than sclerotherapy in controlling HD symptoms, specifically prolapse and bleeding, although post-procedural pain is a frequent complication. Recurrence is similar with both procedures. While waiting for the publication of results with sclerotherapy with new sclerosants, RBL remains the office-based treatment of choice in HD.

In the study, we comment on the article by Qu et al . Internal hemorrhoids are the most common anorectal disorders worldwide with bleeding, prolapse, and difficulty in defecation. Endoscopic rubber band ligation (ERBL) is a safe, convenient, quick, and economical outpatient procedure. The main goal of ERBL is to alleviate prolapse, but the high incidence of recurrence and post-procedural pain are of clinical concern. Polidocanol foam as a local hemostatic and anesthetic agent could reduce the rates of post-procedural pain and bleeding. Endoscopic polidocanol foam sclerobanding (EFSB) is a novel approach that could lift the mucosa for easy ligation and promote increased scarring in the submucosal tissue which translates into long-term relief from prolapse recurrence and reduced 24-h post-procedural pain. The study by Qu et al is a novel multi-center prospective randomized study to compare ERBL and EFSB in patients with grades II and III internal hemorrhoids with one-year follow-up. Results showed that EFSB is a novel therapy for internal hemorrhoids, but future studies with a larger sample, multiple treatment sessions, and long-term follow-up are required to confirm these findings., Competing Interests: Conflict-of-interest statement: We have nothing to disclose for this article., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background Rubber band ligation (RBL) is an effective, well-established, non-surgical option for symptomatic grade II-III hemorrhoid treatment. However, few reports exist about the benefit and risks of RBL in high-risk patients. We herein evaluated the effectiveness and safety of RBL in hemophiliac, human immunodeficiency virus (HIV)-positive and pregnant patients vs. other patients. Methods We retrospectively evaluated the effectiveness of RBL, during the period 2001-2021, in 3 distinct patient categories deemed high-risk and thus not suitable for anesthesia and/or surgical management of their hemorrhoids: hemophiliacs, HIV-positive patients, and pregnant women. These were compared to matched controls, selected from our outpatient pool, who had no major comorbidities and who had opted for RBL as the primary method of treatment. Results There were 3 study groups (44 with hemophilia, 29 HIV-positive patients, and 45 pregnant women) and controls respectively matched for grade, sex and age (2 for each one in the study groups). Hemophilia patients needed up to 6 RBL sessions for relief of symptoms (3.22 sessions/patient) compared to controls, who needed up to 4 sessions (1.88 sessions/patient, P<0.001); in the other 2 groups there was no difference. There were 3 minor complications: one minor bleeding in a hemophilia patient, a thrombosis in an HIV-positive patient, and severe rectal pain in a control patient. Patients were followed-up for at least 1 year. Conclusion RBL is a safe and effective procedure in hemophiliacs, HIV-positive patients and pregnant women, with low complication rates for grade I-III hemorrhoids, similar to those in healthy matched controls. [ABSTRACT FROM AUTHOR]

Objective: To compare rubber band ligation (RBL) vs standard hemorrhoidectomy for the treatment of haemorrhoids. Study Design: Quasi-experimental study. Place and Duration of Study: Department of General Surgery, Pak Emirates Military Hospital Rawalpindi, from Feb 2020 to Jan 2021. Methodology: A total of 200 patients with 2nd and 3rd-degree haemorrhoids who met the inclusion and exclusion criteria were included in the study. Group-A patients underwent rubber band ligation, while in Group-B, Milligan Morgan hemorrhoid-dectomy was done. Results: There were 200 patients (100 in each Group). There were 135 males (67.5%) and 65 females (32.5%). The female to male ratio was 1:2.01. Mean age was 44.73±8.36 years in Group-A and 43.48±8.98 years in Group-B. Mean duration of complaints was 8.72±4.32 months in Group-A and 10.89±3.80 in Group-B. Post-procedure patients were called for follow up in a third and eighth week. The most common complication seen in Group-A was recurrence which was 18% (p-value 0.001), and pain in Group-B, 82% (p-value 0.001), which was statistically significant. Conclusion: We concluded that Rubber band ligation is a quick, safe and cost-effective procedure for the outpatient department for Grade II and III haemorrhoids. The recurrence rate is high compared to standard hemorrhoid-dectomy, but its advantages make it a first-line procedure for Grade II and III haemorrhoids in the outpatient departments. [ABSTRACT FROM AUTHOR]

We have read the article by Qu et al with great interest, as it presents an integration of endoscopic polidocanol foam sclerotherapy with rubber band ligation in patients with Grade II-III internal hemorrhoids. The authors conducted a prospective, multicenter, randomized study to evaluate the long-term symptomatic and endoscopic efficacy of this combined intervention. In this discussion, we focus on the procedural steps of this combined strategy and suggest potential avenues for future research., Competing Interests: Conflict-of-interest statement: The authors declare that they have no conflicts of interest., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Hemorrhoids are a common and painful condition, with conventional treatments such as endoscopic rubber band ligation (ERBL) and injection sclerotherapy often falling short due to high recurrence rates and significant post-operative pain. A clinical trial by Qu et al introduces a novel approach called endoscopic poli-docanol foam sclerobanding (EFSB). This multicenter randomized trial involved 195 patients with grade II and III internal hemorrhoids and demonstrated that EFSB significantly reduced recurrence rates and post-procedural pain while improving symptom relief and patient satisfaction compared to ERBL. The study's strengths include its robust design, comprehensive outcome evaluation, and patient-centered approach. Despite limitations such as the single-blind design and relatively short follow-up period, the findings suggest that EFSB could enhance clinical practice by offering a more effective and patient-friendly treatment option. Further research is needed to validate these results and explore the long-term benefits and cost-effectiveness of EFSB., Competing Interests: Conflict-of-interest statement: All the authors declare that they have no conflict of interest., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

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Background: The pursuit of better management for haemorrhoidal disease (HD) is far from over, and even with the latest surgical procedures, none of the treatment options is close to perfect. The aims of this study were to review our experience with patients treated for symptomatic HD, compare the different treatment strategies in terms of complication and recurrence rates and determine predictors of recurrence. Methods: A total of 1958 patients who underwent a procedure for HD performed by a single colorectal consultant surgeon between 2000 and 2015 were reviewed. Results: The treatment performed was rubber band ligation (RBL) in 73%, excisional haemorrhoidectomy (EH) in 16% and stapled haemorrhoidopexy (SH) in 11%. After a mean follow‐up of 42.1 months, 242 patients (12%) developed recurrence. Logistic regression analysis of multiple factors showed that treatment received was a significant predictor of recurrence. RBL had the lowest post‐operative complication rate but had the highest recurrence rate. EH had the lowest recurrence rate. SH had the highest complication rate but with similar recurrence rates to EH. Complications included pain, anal fissure, bleeding and urinary retention. Conclusion: Low‐grade HD can initially be treated with RBL with good results. Although conventional EH remains a mainstay operation for recurrent and complicated HD, SH can also be considered in selected cases particularly when performed by a surgeon with adequate experience. Treatment should be tailored to the individual based on patient preference, suitability, degree of haemorrhoids and symptomatology. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this prospective study is to present the results of rubber band ligation (RBL) in 2635 consecutive patients with 2nd, 3rd, and 4th degree symptomatic hemorrhoids, the pain risk factors, and the applicability of the method in patients with liver cirrhosis and portal hypertension. Methods: A total of 1256 patients with 2nd, 1159 with 3rd, and 220 with 4th degree hemorrhoids were included in the study. Fifty-seven patients with hemorrhoids had liver cirrhosis and portal hypertension. RBL was performed using St Marks', McGinvey, and suction ligators. Single ligation was done in 178 patients, while 2457 patients had synchronous multiple ligations, in one (272), two (1289), and three (896 patients) sessions. Results: After the end of treatment, 86.8% of our patients were asymptomatic and 84.5% remained asymptomatic 2 years later. A total of 593 patients had complications. Thirty required hospitalization, while pain was the most frequent complication (16.16 %). Multiple banding, young age, male sex, and external hemorrhoids were pain risk factors. RBL proved to be safe in 57 patients with coagulation disorders due to cirrhosis. Symptomatic recurrence was detected in 327 out of 2110 patients (15.49%), with repeat RBL in 219 cases and surgery in 108 cases. Conclusion: RBL is a safe, effective method for treating symptomatic 2nd and 3rd degree hemorrhoids. It can also be applied in selected cases of 4th degree hemorrhoids and patients with cirrhosis and portal hypertension. [ABSTRACT FROM AUTHOR]

Background: Haemorrhoids are common anorectal conditions seen in surgical practice, with various treatment modalities. This study compared the short-term outcome of injection sclerotherapy with 50% dextrose in water and rubber band ligation in the management of second-and third-degree haemorrhoids, in terms of symptoms improvement, complications, recurrence rate, retreatment rate and acceptability. Methodology: This was a prospective comparative study that was carried out in the endoscopic unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, in southwestern Nigeria. Sixty consecutive patients with second- and third-degree haemorrhoids, who consented, were recruited into the study and were randomised into two groups. Group A had endoscopic injection sclerotherapy and Group B had endoscopic rubber band ligation. Results: With regard to anal protrusion, more patients consistently reported either complete (16 [64.4%]) or partial (9 [40.9%]) resolution of symptoms in Group B, compared to Group A which had 7 (28.0%) and 5 (22.7%) cases, respectively (P = 0.03). Resolution of anal bleeding was initially more in Group B than A (22 [95.7%] vs. 17 [77.3%] patients, respectively), in the first 24-h post-treatment; however, within the 1st week, this ratio was reversed (P = 0.07). The retreatment rate for Group A and B was 23.3% and 13.3%, respectively,P = 0.34. More patients in Group B experienced severe pain post-treatment compared to Group A (P = 0.01). Three-month post-treatment, two (11.8%) patients in Group A and one (4.5%) in Group B had recurrence of anal bleeding (P = 0.42). There was no recurrence in anal protrusion in both treatment groups. Conclusion: Endoscopic rubber band ligation had a significantly higher success rate than endoscopic injection sclerotherapy, in terms of resolution of anal protrusion, but with higher pain score.

Background: The aim of this study was to review clinical outcome of haemorrhoidectomy and rubber band ligation in grade II–III haemorrhoids. Methods: A systematic review was conducted. Medline, Embase, Cochrane Library, Clinicaltrials.gov, and the WHO International Trial Registry Platform were searched, from inception until May 2018, to identify randomised clinical trials comparing rubber band ligation with haemorrhoidectomy for grade II–III haemorrhoids. The primary outcome was control of symptoms. Secondary outcomes included postoperative pain, postoperative complications, anal continence, patient satisfaction, quality of life and healthcare costs were assessed. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Results: Three hundred and twenty-four studies were identified. Eight trials met the inclusion criteria. All trials were of moderate methodological quality. Outcome measures were diverse and not clearly defined. Control of symptoms was better following haemorrhoidectomy. Patients had less pain after rubber band ligation. There were more complications (bleeding, urinary retention, anal incontinence/stenosis) in the haemorrhoidectomy group. Patient satisfaction was equal in both groups. There were no data on quality of life and healthcare costs except that in one study patients resumed work more early after rubber band ligation. Conclusions: Haemorrhoidectomy seems to provide better symptom control but at the cost of more pain and complications. However, due to the poor quality of the studies analysed/it is not possible to determine which of the two procedures provides the best treatment for grade II–III haemorrhoids. Further studies focusing on clearly defined outcome measurements taking patients perspective and economic impact into consideration are required. [ABSTRACT FROM AUTHOR]

Background: Endoscopic rubber band ligation (ERBL) is a nonsurgical technique for the treatment of symptomatic internal hemorrhoids but is limited by recurrence and post-procedural pain., Aim: To evaluate satisfaction, long-term recurrence, and post-procedural pain in managing internal hemorrhoids using a combination of polidocanol foam sclerotherapy and ERBL., Methods: This was a prospective, multicenter, randomized study. A total of 195 consecutive patients diagnosed with grade II-III internal hemorrhoids were enrolled from four tertiary hospitals and randomly divided into a cap-assisted endoscopic polidocanol foam sclerobanding (EFSB) or an ERBL group. All patients were followed-up for 12 months. Symptom-based severity and post-procedural pain were assessed using a hemorrhoid severity score (HSS) and a visual analog scale (VAS). Continuous variables were reported as medians and interquartile range., Results: One hundred and ninety-five patients were enrolled, with 98 in the EFSB group. HSS was lower in the EFSB group than in the ERBL group at 8 weeks [4.0 (3.0-5.0) vs 5.0 (4.0-6.0), P = 0.003] and 12-month [2.0 (1.0-3.0) vs 3.0 (2.0-3.0), P < 0.001] of follow-up. The prolapse recurrence rate was lower in the EFSB group at 12 months (11.2% vs 21.6%, P = 0.038). Multiple linear regression analysis demonstrated that EFSB treatment [B = -0.915, 95% confidence interval (CI): -1.301 to -0.530, P = 0.001] and rubber band number (B = 0.843, 95%CI: 0.595-1.092, P < 0.001) were negatively and independently associated with the VAS score 24 hours post-procedure. The median VAS was lower in the EFSB group than in the ERBL [2.0 (1.0-3.0) vs 3.0 (2.0-4.0), P < 0.001]., Conclusion: Cap-assisted EFSB provided long-term satisfaction and effective relief from the recurrence of prolapse and pain 24 hours post-procedure., Competing Interests: Conflict-of-interest statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Hemorrhoids and anal fissures are two of the most common benign anorectal diseases. Despite their high prevalence, diagnostic accuracy of benign anorectal disease is suboptimal at 70% for surgeons, especially for hemorrhoidal diseases. Once the diagnosis is correctly made, numerous medical and surgical treatment options are available, each with different rates of success and complications. In this article, the authors review each step of patient management, with emphasis on evidence-based treatment options for hemorrhoids and anal fissures. The article discusses the pathophysiology, diagnosis, medical management, and procedures for hemorrhoids followed by a detailed overview on the management of anal fissures., (Copyright © 2023 Elsevier Inc. All rights reserved.)

The article presents the results of surgical treatment of patients with stages III to IV hemorrhoids followed by an observation period of 45 days, which is designed to improve the results of surgical treatment of this category of patients. The surgical treatment methods included doppler-guided transanal hemorrhoiddearterialization with mucopexy (DDM) (Group I) and harmonic scalpel hemorrhoidectomy (HSH) (Group II). Operated patients underwent all necessary examinations according to the “per protocol” principle. Study Design: single-center controlled randomized prospective. The effectiveness of DDM was comparable to that of hemorrhoidectomy (HE), which made it possible to significantly reduce the duration of the operation (DDM 17.9 ± 6.1 min, GE 34.5 ± 10.1 min (p

Background: Hemorrhoids are one of the most common diseases in the world, with a high prevalence that includes all age groups and both sexes. Rubber band ligation (RBL) is a non-invasive, non-operative treatment that can be done in an outpatient. Objectives: The study was conducted to determine the effectiveness of (RBL) treatment of hemorrhoids grade I-III and follow-up of these patients to evaluate this type of treatment in terms of symptomatic relief and recurrence of hemorrhoids and its complications. Study design: A prospective, and interventional study was undertaken over the period of 2 years in two private clinics with a sample size of 479 patients with internal hemorrhoids. Result: Out of 479 patients with internal hemorrhoids, 94.8% was male. The success rate was 80.4% and it is a relatively high rate. There were no major complications were noticed in this study, despite of simple minor complication that are encountered in any surgical procedures, include very mild pain (16.2%), retention of urine (14.4%), vasovagal attack (5.2%), mild infection at the site of the procedure (5.6%), thrombosis (5.4%), few drops bleeding (9.6%). All these complications need simple treatments. Conclusions: RBL was easy, non-complicated safe surgical procedure for the treatment of internal hemorrhoids can be done in the outpatient clinic with high rate of successful and minor complications. [ABSTRACT FROM AUTHOR]

Introduction: Pain is the most common complication of rubber band ligation (RBL) of hemorrhoids when compared to other non-operative techniques to treat hemorrhoids. Local anesthetic injection has been used in a few studies to reduce pain after RBL but its routine use is still not established. We evaluated the effectiveness of local injection of bupivacaine after RBL of hemorrhoids to reduce pain after the procedure. Objective: To compare the mean pain scores by visual analogue scale with and without local injection of bupivacaine after RBL of 1st and 2nd degree hemorrhoids. Design: Randomized controlled trial. Material and Methods: Study was conducted in Surgical unit 1, Civil Hospital, Karachi, for a period of 2 months, from Aug 17, 2016 to Oct 17, 2016. 60 patients having first and second degree hemorrhoids were included in the study from OPD by non-probability consecutive sampling. They were randomized to either to receive local injection of bupivacaine or no injection after RBL of hemorrhoids by closed envelop method. Pain score at 2 hours after the procedure was the main outcome measured. Results: Our study showed that there was a significant reduction in the pain at 2 hours after RBL of hemorrhoids with the use of local bupivacaine injection, mean pain scores 3.30 ± 1.055 when compared to 3.93 ± 0.944 in patients without administration of bupivacaine with p-value = 0.017. Conclusion: Our study concluded that local bupivacaine injection may be used routinely after RBL of hemorrhoids to reduce pain after the procedure.

Aim: Comparison the application and effectiveness of hemorrhoidal artery ligation (HAL) and rubber band ligation (RBL) techniques in the treatment of grade II and III hemorrhoidal disease. Method: HAL was performed in 50 patients between December 2006 and May 2007 and RBL was performed in 96 patients between August 2011 and October 2014. A total of 146 patients with grade II-III hemorrhoidal disease were included in this retrospective study. Surgery duration, performed ligations, pain on postoperative day 7 visual analog scale, complications, and ratio of symptom-free patients at 6 months were statistically analyzed for both procedures. Results: Patients who underwent HAL returned to work earlier and had less pain on postoperative day 7 than those who underwent RBL; in addition, the RBL procedure was statistically more cost-effective and had shorter surgery times. There was no statistical difference between the HAL and RBL groups in proportion of patients who were symptom-free at postoperative 6 months (94% and 96.6%, respectively). Conclusion: The RBL and HAL procedures are both effective and have low complication, and can be used safely together or separately in the treatment of grade II-III hemorrhoidal disease.

Endoscopic polypectomy is essential for the prevention of Peutz-Jeghers syndrome-associated complications, including intussusception, intestinal obstruction, and malignant transformation. Conventional polypectomy is the preferred approach, but it can be challenging to achieve in patients with Peutz-Jeghers syndrome because of the high polyp burden and polyps located in areas with difficult endoscopic access. This case report highlights 2 different techniques of ischemic polypectomy and its advantage compared with conventional polypectomy in this subset of patients., (© 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)