Randomized prospective study of endoscopic rubber band ligation compared with bipolar coagulation for chronically bleeding internal hemorrhoids

Abstract

Objectives: Our purpose was to compare the efficacy, complications, success rate, recurrence rate at 1 year, and crossovers of rubber band ligation (RBL) with those of bipolar electrocoagulation (BPEC) treatment for chronically bleeding internal hemorrhoids.

Methods: A total of 45 patients of mean age 51.5 years, who had rectal bleeding from grade II or III hemorrhoids and in whom intensive medical therapy failed, were randomized in a prospective study comparing RBL with BPEC. Treatment failure was predefined as continued bleeding, occurrence of a major complication, or failure to reduce the size of all internal hemorrhoidal segments to grade I in < or =3 treatments. Patients were followed up for 1 year.

Results: With similar patients, rectal bleeding and other symptoms were controlled with significantly fewer treatments of RBL than of BPEC (2.3+/-0.2 vs. 3.8+/-0.4, P<0.05), and RBL had a significantly higher success rate (92% vs. 62%, P<0.05). RBL had more cases of severe pain during treatment (8% vs. 0%, P<0.05), but significantly fewer failures and crossovers (8% vs. 38%). Symptomatic recurrence at 1 year was 10% RBL and 15% BPEC.

Conclusions: For patients with chronically bleeding grade II or III internal hemorrhoids that are unresponsive to medical therapy, safety and complication rates of banding and BPEC were similar. The success rate was significantly higher with RBL than with BPEC. Symptom recurrence rates at 1 year were similar.

Figure 1

CONSORT diagram. BPEC, bipolar electrocoagulation probe; RBL, rubber band ligation.

Figure 2

Grade II internal hemorrhoids: RBL treatment. (a and b) Slotted-anoscope images of grade II internal hemorrhoids. (c) Endoscopic suction of internal hemorrhoid segment through single-shot ligator on an endoscope. (d) Banding placed end-on, above the dentate line. (e) Internal hemorrhoid segment banded above the dentate line. (f) Four internal hemorrhoids banded—retroflexion after removal of RBL cap.

Figure 3

Grade II internal hemorrhoids: BICAP treatment. (a) Grade II internal hemorrhoid segment as shown through a slotted anoscope. (b) Bipolar coagulation probe treatment above the dentate line of a grade II segment.