Hemorrhoidal elastic band ligation during routine colonoscopy: A comparative study between flexible video endoscopy and rigid proctoscopy

Abstract

BACKGROUND

Among patients referred for colonoscopy to evaluate bowel bleeding, many present with hemorrhoidal disease-associated bleeding and prolapse.

AIM

To compare endoscopic band ligation (EBL) with rigid proctoscope band ligation (RPBL) in patients referred for colonoscopy due to internal hemorrhoids.

METHODS

This retrospective cohort study included 171 patients with previous anal bleeding and hemorrhoidal prolapse complaints who underwent routine colonoscopy who were referred for band ligation treatment. Seventy-five patients underwent EBL, and 96 underwent RPBL. Control of bleeding, prolapse recurrence, pain, tenesmus, overall satisfaction, and cost were analyzed. A log-binomial regression model was used to analyze and compare binary outcomes between the ligation types, which allowed for the direct estimation of relative risks.

RESULTS

EBL achieved hemorrhoid symptom control in 92% of patients after a single session, compared with 63.5% for RPBL, which typically required three to four sessions (P < 0.01). Short-term prolapse was significantly lower with EBL (13.3%) than with RPBL (55.2%, P < 0.01), and long-term prolapse recurrence remained lower (8% vs 36.5%, P < 0.01). Short-term bleeding was also reduced with EBL (4% vs 19%, P < 0.01), while long-term bleeding control was comparable between groups (97.3% vs 92.7%). RPBL patients were more likely to report pain (relative risk = 1.29; 95% confidence interval: 1.08-1.54; P < 0.01). Overall satisfaction was markedly higher in the EBL group (86.7% “very satisfied”) than in the RPBL group (24%, P < 0.01).

CONCLUSION

EBL demonstrated superior control of hemorrhoidal symptoms, lower prolapse recurrence, and better short-term bleeding outcomes compared with RPBL. Long-term bleeding control and tenesmus rates were comparable; however, numerical trends favored EBL. Despite a higher per-session cost, the reduced number of sessions made overall expenses similar. EBL appears to be a more effective, efficient, and well-tolerated minimally invasive option for treating symptomatic internal hemorrhoids.

Keywords: Hemorrhoids; Hemorrhage; Prolapse; Ligation; Colonoscopy

Core Tip: A practical implication of anal examination during colonoscopy is the possibility of immediate treatment of bleeding or prolapse through elastic band ligation. This procedure can be performed via rigid proctoscope band ligation (RPBL) or endoscopic band ligation (EBL). In this study, EBL controlled symptoms in a single application in 92% of patients, whereas RPBL controlled symptoms in 63.54% of patients over 3 sessions or 4 sessions (P < 0.01). EBL was superior to RPBL in terms of internal hemorrhoid symptom control, prolapse recurrence, and short-term bleeding control. Long-term bleeding control and tenesmus rates were comparable, although numerical trends favored EBL. Both methods were similar in terms of costs.