Gomes A, Barrio E, Gomes G, Souza JHCG, Pinto PCC, Borghesi RA. Hemorrhoidal elastic band ligation during routine colonoscopy: A comparative study between flexible video endoscopy and rigid proctoscopy. World J Gastrointest Endosc 2025; 17(12): 114581 [DOI: 10.4253/wjge.v17.i12.114581]
Corresponding Author of This Article
Alexandre Gomes, Adjunct Professor, Department of Surgery, Faculty of Medical Sciences and Health, Pontifical Catholic University of São Paulo, Rua Dr. Luiz Garcia Duarte 125, Sorocaba 18030-070, São Paulo, Brazil. endoclinic@endoclinic.med.br
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Gastroenterology & Hepatology
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Retrospective Cohort Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 16, 2025 (publication date) through Dec 19, 2025
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World Journal of Gastrointestinal Endoscopy
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1948-5190
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Gomes A, Barrio E, Gomes G, Souza JHCG, Pinto PCC, Borghesi RA. Hemorrhoidal elastic band ligation during routine colonoscopy: A comparative study between flexible video endoscopy and rigid proctoscopy. World J Gastrointest Endosc 2025; 17(12): 114581 [DOI: 10.4253/wjge.v17.i12.114581]
World J Gastrointest Endosc. Dec 16, 2025; 17(12): 114581 Published online Dec 16, 2025. doi: 10.4253/wjge.v17.i12.114581
Hemorrhoidal elastic band ligation during routine colonoscopy: A comparative study between flexible video endoscopy and rigid proctoscopy
Alexandre Gomes, Enzo Barrio, Guilherme Gomes, José Henrique Carvalho Gandini de Souza, Pérsio Campos Correia Pinto, Ronaldo Antonio Borghesi
Alexandre Gomes, Enzo Barrio, Guilherme Gomes, José Henrique Carvalho Gandini de Souza, Pérsio Campos Correia Pinto, Ronaldo Antonio Borghesi, Department of Surgery, Faculty of Medical Sciences and Health, Pontifical Catholic University of São Paulo, Sorocaba 18030-070, São Paulo, Brazil
Author contributions: Gomes A contributed to the original idea, study design, procedure development, supervision of the study and writing of the manuscript; Gomes A, Barrio E, Souza JHCCd, and Gomes G contributed to data analysis and interpretation; Barrio E, Souza JHCCd, and Gomes G contributed to data acquisition and drafting of the manuscript; Pinto PCC and Borghesi RA contributed to the review, editing, and approval of the final version of the manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Faculty of Medical Sciences and Health, Pontifical Catholic University of São Paulo (Approval No. 7.776.404).
Informed consent statement: This research was retrospective, and the requirement for informed consent was waived.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: No additional data is available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alexandre Gomes, Adjunct Professor, Department of Surgery, Faculty of Medical Sciences and Health, Pontifical Catholic University of São Paulo, Rua Dr. Luiz Garcia Duarte 125, Sorocaba 18030-070, São Paulo, Brazil. endoclinic@endoclinic.med.br
Received: September 25, 2025 Revised: October 11, 2025 Accepted: November 11, 2025 Published online: December 16, 2025 Processing time: 84 Days and 3.6 Hours
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.
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.
