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Efficacy of two endoscopic rubber band ligation methods for symptomatic hemorrhoids: a randomized controlled trial

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Abstract

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.

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Acknowledgements

The authors thank all study participants who participated in the present study.

Funding

The present study was funded by the Clinical Capacity Enhancement Project of the First Affiliated Hospital of Nanjing Medical University (JSPH-MC-2022–5). The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, No.300 of Guangzhou Road, Nanjing, 210029, China

    Li Tian, Chun Yu, Yue Qin, Yaoyao Gong & Wenfang Cheng

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  1. Li Tian
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  2. Chun Yu
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  3. Yue Qin
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  4. Yaoyao Gong
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  5. Wenfang Cheng
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Contributions

WC, YG, and LT were involved in the study conception and study design. WC and YG obtained the funding. All authors were involved in the implementation of the study and interpreting the data. LT, CY, YQ, and YG participated in the statistics of the study. LT and YG, with the help of WC, wrote the manuscript. All authors have read and approved the final manuscript.

Corresponding authors

Correspondence to Yaoyao Gong or Wenfang Cheng.

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Disclosures

Drs. Li Tian, Chun Yu, Yue Qin, Yaoyao Gong, and Wenfang Cheng have no conflicts of interests or financial ties to disclose.

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Tian, L., Yu, C., Qin, Y. et al. Efficacy of two endoscopic rubber band ligation methods for symptomatic hemorrhoids: a randomized controlled trial. Surg Endosc 37, 6235–6245 (2023). https://doi.org/10.1007/s00464-023-10108-8

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  • DOI: https://doi.org/10.1007/s00464-023-10108-8

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