A retrospective cohort study of the efficacy and safety of endoscopic ligation versus injection sclerotherapy for internal hemorrhoids
10.3760/cma.j.cn321463-20240710-00323
- VernacularTitle:内镜下套扎与硬化剂注射治疗内痔有效性及安全性的回顾性队列研究
- Author:
Li GAO
1
;
Weixuan YANG
;
Li TIAN
;
Yaoyao GONG
;
Wenfang CHENG
Author Information
1. 南京医科大学第一附属医院消化内科，南京 210029
- Publication Type:Journal Article
- Keywords:
Hemorrhoids;
Internal hemorrhoids;
Sclerotherapy;
Ligation;
Efficacy;
Complications
- From:
Chinese Journal of Digestive Endoscopy
2024;41(12):973-978
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the efficacy and safety of endoscopic ligation and injection sclerotherapy for internal hemorrhoids.Methods:From April 2020 to October 2023, 106 patients with grade Ⅰ to Ⅲ internal hemorrhoids who underwent endoscopic ligation or injection sclerotherapy in the First Affiliated Hospital with Nanjing Medical University (Jiangsu Province People's Hospital) were consecutively enrolled in the retrospective cohort study. Patients were divided into the ligation group ( n=70) and the injection sclerotherapy group ( n=36) according to the endoscopic treatment methods. The effective rate, hospital stay, postoperative pain, the incidence of complications, patient satisfaction and the recurrence rate of the two groups were assessed. Results:The effective rate was 95.7% (67/70) and 100.0% (36/36) respectively in the ligation group and the injection sclerotherapy group without significant difference ( P=0.549). The hospital stay was 6.0 (4.0, 7.3) days and 3.0 (2.0, 4.0) days respectively in the ligation group and the injection sclerotherapy group with significant difference ( Z=4.305, P<0.001). The incidence of 24-hour postoperative pain was 58.6% (41/70) and 11.1% (4/36) in the two groups respectively and the difference was statistically significant ( χ2=20.020, P<0.001). There were no serious postoperative adverse events such as anal stenosis or thrombotic external hemorrhoids in the two groups. Only the incidence of anal distension was significantly different between the ligation group and the injection sclerotherapy group [38.6% (27/70) VS 5.6% (2/36), χ2=11.431, P<0.001]. The patient satisfaction rate of the two groups showed no significant difference [87.1% (61/70) VS 86.1% (31/36), P=1.000]. There was 1 patient and 15 patients lost to follow-up respectively in the ligation group and the injection sclerotherapy group, and the recurrence rate of the two groups showed no significant difference [14.5% (10/69) VS 33.3% (7/21), P=0.064]. Subgroup analysis of grade Ⅰ-Ⅱ internal hemorrhoids: there were 43 patients and 29 patients in the ligation group and the injection sclerotherapy group, respectively. No significant difference was found between the two groups in terms of the effective rate, incidence of postoperative hemorrhage, incidence of uroschesis, or patient satisfaction rate ( P>0.05). The incidences of postoperative pain [65.1% (28/43) VS 10.3% (3/29), χ 2=19.016, P<0.001] and anal distension [41.9% (18/43) VS 3.4% (1/29), χ 2=11.252, P<0.001] of the ligation group were significantly higher than those of the injection sclerotherapy group. Forty-three patients in the ligation group and 17 patients in the injection sclerotherapy group completed follow-up, and the recurrence rate was 11.6% (5/43) and 23.5% (4/17), respectively, without significant difference ( P=0.256). Subgroup analysis of grade Ⅲ internal hemorrhoids: there were 27 patients in the ligation group and 7 patients in the injection sclerotherapy group, and 26 and 4 patients completed follow-up, with a recurrence rate of 19.2% (5/26) and 75.0% (3/4), respectively. Conclusion:Endoscopic ligation and injection sclerotherapy are both safe and effective for grade Ⅰ-Ⅲ internal hemorrhoids. Injection sclerotherapy demonstrates shorter hospital stays and lower incidences of postoperative pain and anal distension. For grade Ⅰ-Ⅱ internal hemorrhoids, injection sclerotherapy is recommended due to its efficacy and fewer complications. Conversely, for grade Ⅲ internal hemorrhoids, ligation is suggested to reduce recurrence rates.
