Endoscopic polidocanol foam sclerobanding for the treatment of grade Ⅱ-Ⅲ internal hemorrhoids:A prospective,multi-center,randomized study

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.

Endoscopic polidocanol foam sclerobanding for the treatment of Grade Ⅱ-Ⅲ internal hemorrhoids:The focus of clinical practice

We have read the article by Qu et al with great interest,as it presents an inte-gration 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 sympto-matic 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.

Endoscopic polidocanol foam sclerobanding for treatment of internal hemorrhoids:A novel outpatient procedure

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 postprocedural 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.

Massive gastrointestinal bleeding after endoscopic rubber band ligation of internal hemorrhoids:A case report

BACKGROUND Rubber band ligation(RBL) using rigid anoscope is a commonly recommended therapy for grade Ⅰ-Ⅲ symptomatic internal hemorrhoids. Severe complications of RBL include pain, hemorrhage and sepsis. Flexible endoscopic RBL(ERBL) is now more commonly used in RBL therapy but few severe complications have been reported. Here we report on a case of massive bleeding after ERBL.CASE SUMMARY A 31-year-old female was admitted to the department of gastroenterology with a chief complaint of discontinuous hematochezia for 2 years. No previous history, accompanying diseases or drug use was reported. Physical examination and colonoscopy showed grade Ⅱ internal hemorrhoids. The patient received ERBL therapy. Five days after ligation, the patient presented with mild hematochezia. On days 7 and 9 after ligation, she presented with a large amount of rectal bleeding, dizziness and weakness. Emergency colonoscopy revealed active bleeding and an ulcer in the anal wound. The patient received two sessions of hemoclipping on days 7 and 9 to treat the bleeding. No further bleeding was reported up to day 15 and she was discharged home. Although the hemorrhoid prolapse disappeared after ERBL, she was dissatisfied with the subsequent complications.CONCLUSION ERBL therapy is an effective treatment for symptomatic internal hemorrhoids with satisfactory short and long-term recovery. Pain and anal bleeding are the most frequently reported postoperative complications. Coagulation disorders complicate the increased risk of bleeding. Although rarely reported, our case reminds us that those patients without coagulation disorders are also at risk of massive life-threatening bleeding and need strict follow-up after ligation.

Prospective evaluation of the hemorrhoid energy treatment for the management of bleeding internal hemorrhoids

BACKGROUND The hemorrhoid energy treatment(HET)system is a non-surgical bipolar electrotherapy device,which has previously demonstrated efficacy in the management of bleeding Grade I and II internal hemorrhoids;however,data is limited.AIM To prospectively assess the safety and efficacy of the HET device.METHODS This was an IRB-approved prospective study of 73 patients with Grade I or II internal hemorrhoids who underwent HET from March 2016 to June 2019.Patient factors and procedural data were obtained.A post-procedure questionnaire was administered by telephone to all patients at 1-wk and 3-mo following HET to assess for improvement and/or resolution of rectal bleeding and adherence to a stool softener regimen.A chart review was performed to observe recurrent symptoms and durability of response.Statistical analyses were performed using SPSS software(IBM;SPSS Version 25.0).RESULTS Seventy-three patients underwent HET during the study period.Mean post-HET follow-up was 1.89 years.Complete resolution of bleeding was reported in 65%at 1 wk(n=48),with improvement in bleeding in 97.2%(n=71)of patients.At 3-mo,resolution and/or improvement in bleeding was reported in 90%(n=64)of patients.No procedure-related pain or adverse events were reported.CONCLUSION HET is well tolerated,safe and highly effective in the majority of our patients presenting with Grade I and II symptomatic internal hemorrhoids.

Comparing the Effect of An's Shaobei Injection(安氏芍倍注射液) with Xiaozhiling Injection(消痔灵注射液) in Patients with Internal Hemorrhoids of GradeⅠ-Ⅲ:A Prospective Cohort Study

Objective： To compare the effect of An＇s Shaobei Injection （安氏芍倍注射液） with Xiaozhiling Injection （消痔灵注射液） in patients with internal hemorrhoids of grade 1-11I. Methods： This cohort study included 1,520 internal hemorrhoids patients with grade Ⅰ-Ⅲ who were scheduled for liquid injection treatment from July 2003 to July 2009. The cohort included patients who underwent either An＇s Shaobei Injection treatment （the treatment group, 760 cases） or Xiaozhiling Injection treatment （the control group, 760 cases）. All patients were followed up regularly for 3 years; the observing indices included anal function recovery and clinical response after operation. Results： Among the 1,520 patients, 1,508 （99.2%） completed the 3-year follow-up. The efficacy rate was 97.5% in the treatment group, significantly higher than the control group （91.8%, P〈0.01）. The recurrence rate in the treatment group was 0.5%, significantly lower than that of the control group （1.3%, P〈0.01）. In addition, perianal callosity occurred in 8 cases （1.1%） and anorectal stricture in 26 cases （3.5%） after operation in the control group. There was no perianal callosity and anorectal stricture in the treatment group. Conclusion： The treatment with An＇s Shaobei Injection demonstrated superior clinical effect to Xiaozhiling Injection with fewer adverse effects.