Endoscopic Treatment of Internal Hemorrhoids

  • Alessandra BizzottoEmail author
  • Manuela Codazzi
  • Cristiano Spada
Living reference work entry
Part of the Coloproctology book series (COLOPROCT)


Hemorrhoids represent pathological changes in the physiological anal cushions and are one of the most common ano-rectal diseases. Hemorrhoids are divided in two main groups, internal and external. Internal hemorrhoidal complexes are furthermore conventionally categorized in IV grades according to their extent, tendency to prolapse, and reducibility (Goligher’s classification). Regardless to pathogenesis, the appropriate assessment of hemorrhoids is crucial to treatment. Once nonhemorrhoidal reasons for complaints have been ruled out, patients suffering from symptomatic low-graded internal hemorrhoids are initially best served with medical conservative behavioral approach with the aim of relief symptoms. When conservative treatments fail, patients are amenable to nonsurgical ablative office-based procedures. Rubber band ligation, injection sclerotherapy, and infrared coagulation are the three viable evidence-based treatment alternatives. These treatment modalities are well-established, relatively well-tolerated, almost effective, and furthermore repeatable procedures and can be performed using an anoscope or proctoscope or during flexible endoscopy, the latter with substantial advantages and minimal or no adjunctive equipment. According to the available literature, rubber band ligation is associated with better long-term efficacy and lower sessions needed for treatment with acceptable complication rates and is therefore advised as the first-line treatment option. However, sclerotherapy and infrared thermocoagulation may still be suitable in specific circumstances and subset of patients. Despite grade of disease and patients’ conditions and expectations, the choice between the different options ultimately depends on local expertise, preferences, and facilities.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Alessandra Bizzotto
    • 1
    Email author
  • Manuela Codazzi
    • 1
  • Cristiano Spada
    • 1
  1. 1.Digestive Endoscopy UnitFondazione Poliambulanza Istituto OspedalieroBresciaItaly

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