Abstract
Objective. A new sclerosing agent for hemorrhoids, aluminum potassium sulfate and tannic acid (ALTA), is attracting attention as a curative treatment for internal hemorrhoids without resection. The outcome and safety of ALTA sclerotherapy using an endoscope were investigated in the present study. Materials and Methods. Subjects comprised 83 internal hemorrhoid patients (61 males and 22 females). An endoscope was inserted and retroflexed in the rectum, and a 1st-step injection was applied to the upper parts of the hemorrhoids. The retroflexed scope was returned to the normal position, and 2nd–4th-step injections were applied to the middle and lower parts of the hemorrhoids under direct vision. The effects of endoscopic ALTA sclerotherapy were determined by evaluating the condition of the hemorrhoids using an anoscope and interviewing the patient 28 days after the treatment. Results. A cure, improvement, and failure were observed in 54 (65.1%), 27 (32.5%), and 2 (2.4%) patients, respectively, treated with ALTA. Complications developed in 4 patients (mild fever in 3 and hematuria in 1). Recurrence occurred in 9.6%. Conclusions. The results of the present study suggest that endoscopic ALTA has the potential to become a useful and minimally invasive approach for ALTA sclerotherapy.
Highlights
Hemorrhoids are a very common anal disease and, when formed on the upper and lower sides of the dentate line, are classified as internal and external hemorrhoids, respectively
Rubber band ligation and injection sclerotherapy have been the mainstay of nonsurgical treatments for more than a century and are considered to sufficiently treat hemorrhoids
A meta-analysis of 18 randomized trials that compared various treatment methods for hemorrhoids concluded that rubber band ligation was more effective than sclerotherapy and that patients who underwent ligation were less likely to need subsequent therapy [5]
Summary
Hemorrhoids are a very common anal disease and, when formed on the upper and lower sides of the dentate line, are classified as internal and external hemorrhoids, respectively. Internal hemorrhoids are the most common anal disease, the symptoms of which include hemorrhage and prolapse. Internal hemorrhoids are resolved in part by conservative treatments with suppositories and ointments, in addition to lifestyle improvements and the avoidance of straining on defecation; subsequent treatments may be necessary when symptoms become aggravated and interfere with daily living activities. The treatment of this disease without resection is desirable because internal hemorrhoids are mostly benign. Rubber band ligation and injection sclerotherapy have been the mainstay of nonsurgical treatments for more than a century and are considered to sufficiently treat hemorrhoids. The most common sclerosing agent used is 5% phenol almond oil, which is mainly effective for hemorrhage; its effects on prolapse are considered to be insufficient [5]
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