Endoscopic Band Ligation for the Treatment of Hemorrhoidal Disease

Abstract

BACKGROUND: There are several therapeutic options for symptomatic hemorrhoids, from hygienic and dietary measures to conventional surgery. The best technique adopted for alternative and non-surgical treatment for intermediate grade (II and III) hemorrhoidal disease is rubber band ligation. More recently, the technique has been used with the aid of a gastroscope and a kit of elastic rubber bands for esophageal varices. This technique was called Endoscopic Rubber Band Ligation of hemorrhoids (ERBL). OBJECTIVE: The objective is Compare the results and the incidence of the immediate and late complications in patients undergoing ERBL. The satisfaction with the treatment of patients undergoing different number of rubber band ligatures were also analyzed. METHODS: This is a cohort study included patients undergoing ERBL from 2007 to 2014 at the hospital. The incidence of early and late complications and the satisfaction with the treatment of patients undergoing until two ligatures and patients undergoing three or more ligatures in the same procedure were compared. RESULTS: The study included 116 patients. The most frequently reported symptom was anal bleeding (n=72; 62.1%). The number of rubber band ligatures performed during the ERBL procedure varied from one to six; 84 (72,4%) patients had three or more rubber band ligatures performed during the procedure. No significant associations were observed between the incidence of early or late complications and satisfaction with ERBL among the group subjected until two rubber band ligatures or three or more rubber band ligatures. CONCLUSION: The endoscopic elastic ligation method proved to be a feasible, safe and efficient for the treatment of symptomatic hemorrhoidal disease grades II and III. The technique had moderate rates of immediate and late complications, but most of the complications are considered of low magnitude, easily resolved and without clinical repercussions, no matter how much ligations were performed in the same procedure.

Progress in endoscopic treatment of hemorrhoids

“…The conclusion of the studies was that ERBL is simple, safe, and effective, and has a low recurrence rate, which is worthy of clinical promotion. The latest cohort study [35] of 116 patients designed by Henrique et al found that ERBL was a feasible, safe, and effective method for treating symptomatic grade II-III internal hemorrhoids, but practitioners need to be alert for slight risk of early and late complications.…”

Belgian consensus guideline on the management of hemorrhoidal disease

“…In a study by Lee et al in 1994, most patients tolerated multiple hemorrhoidal banding in a single session but in the group that was treated with more than 1 band, there were more vasovagal symptoms, more edema and more urinary hesitancy (72). A recent cohort study with endoscopic rubber band ligation couldn't show a significant difference in complications between patients who had 1-2 bands, compared to those that were treated with 3 or more band ligations in the same procedure (69) More studies are needed to elucidate these contradictory findings. At this moment, the working group advices not to place more than 2 bands if the classical suction ligation device through a proctoscope is used (expert opinion).…”

“…With a flexible video-endoscope in retrovision in the rectum, hemorrhoids are nicely exposed, and the dentate line is easily seen. Using a classical banding device (for esophageal varices) multiple ligations can be performed within a single procedure (68,69). This single-use multiband device is however not reimbursed in Belgium for this indication.…”

“…Using a handheld suction ligator, 1 to 3 bands can be placed (67). Using an endoscope in retroflex up to 6 bands can be placed (69). In most published series an interval of 3-4 weeks between sessions is proposed.…”

Screening and Prevalence of Internal Hemorrhoids in Patients Undergoing Flexible Colonoscopy

“…Hemorrhoid is a common benign anorectal disease in which are swollen veins present in the anal canal and become clinically detectable when the connective tissue that supports the anorectal region is damaged (1) . The symptoms of Huntington's disease (HD) vary depending on the location and type of HD.…”