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.

Redefining hemorrhoid therapy with endoscopic polidocanol foam sclerobanding

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 polidocanol 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.