Symptomatic Internal Hemorrhoids Research Articles

Endoscopic hemorrhoidal ligation: preliminary clinical experience

Background: Endoscopic hemorrhoidal ligation may provide an alternative to surgical treatment of internal hemorrhoids. This study assessed the safety and efficacy of endoscopic elastic band ligation for bleeding internal hemorrhoids. Methods: Endoscopic hemorrhoid ligation was performed in 20 adult patients who had chronic rectal bleeding attributed to internal hemorrhoids. Elastic band ligation was accomplished using a ligating device attached to the end of a video endoscope. Repeat endoscopy was done 3 weeks after the initial procedure. Results: Seventy band ligations were performed during 23 separate sessions. Post-therapy endoscopy showed reduction of hemorrhoidal size by at least one grade in 19 of 20 patients (95%). Bleeding resolved in 19 of 20 patients (95%) in 5.4 months (mean) of follow-up; 18 of 20 (90%) required only one banding session. No major complications (perforation, secondary bleeding, deep ulceration) occurred in this small group. Conclusions: Preliminary data indicates that endoscopic hemorrhoidal ligation is a safe and effective technique for treating internal hemorrhoids. It holds promise as an important technique for successfully treating and possibly eradicating symptomatic internal hemorrhoids. (Gastrointest Endosc 1998;48:49-52.)

Solo operated haemorrhoid ligator rectoscope. A report on 200 consecutive bandings.

A new solo operated haemorrhoid ligator rectoscope is described by the author. This new ligator consists of a double barreled cone, one fitting precisely inside the other. The device functions as a rectoscope to visualize the wall of the ano-rectum and at the same time the distal end of the interior barrel carries the rubber band and functions as the ligator. After the operator grasps the pile and pulls it into the barrel with a tenaculum, he discharges the band by retracting the internal barrel with a simple flick of the thumb. The tool is greatly simplified and more efficient than prior art. It is easy to operate and clean. The view through the rectoscope is clear and unobstructed. The author also reports on a retrospective analysis of his experience with 200 consecutive bandings of symptomatic internal haemorrhoids. The tool proved to be an effective way of rubberbanding haemorrhoids and similar clinical results as with other rubber band devices were attained, with the added bonus that whenever indicated the device allows for a larger amount of tissue to be banded, which may be desirable when treating mucosal prolapse.

Prospective randomized comparative study of bipolar versus direct current electrocoagulation for treatment of bleeding internal hemorrhoids

Internal hemorrhoids are the most common cause of lower gastrointestinal bleeding. Although new anoscopic therapies are available, few comparative randomized studies have evaluated them in regard to long-term efficacy, recurrence rates, and safety. Our purpose was to compare the treatment of internal hemorrhoids with direct current (Ultroid, Cabot Medical, Langhorn, Pa.) and bipolar (BICAP, Circon ACMI, Stamford, Conn.) hemorrhoid probes. One hundred patients with symptomatic internal hemorrhoids were randomized: 50 to direct current electrocoagulation and 50 to bipolar electrocoagulation. Follow-up and treatment were at 3- to 4-weekly intervals; two to three hemorrhoid segments were treated at each session until relief of symptoms (bleeding, prolapse, and discharge) and a reduction in hemorrhoid size to grade 1 or 0 were noted. The hemorrhoids of 98% of all patients studied were grade 2 or 3; 2% of patients had grade 1 hemorrhoids and none had grade 4 hemorrhoids. At 1 year after treatment, most patients had no (69%) or only mild (23%) recurrence, and a few had severe, symptomatic (8%) hemorrhoid recurrence. A greater recurrence rate was noted after direct current treatment (34%) than bipolar treatment (29%). In contrast, rebleeding at 1 year occurred less frequently after direct current treatment (5%) than after bipolar treatment (20%). Our conclusions were as follows: (1) Both direct current and bipolar probes were effective for control of chronic bleeding from grade 1 to 3 internal hemorrhoids. (2) Bipolar probe was significantly faster than direct current probe. (3) Direct current treatment produced fewer complications than bipolar treatment (12% versus 14%). (4) Recurrence rates were low after 1 year with either device (8%). (5) More recurrences were noted after direct current electrocoagulation (34%) than after bipolar electrocoagulation (29%). (Gastrointest Endosc 1994;40:403-10.)

Complications of rubber band ligation of symptomatic internal hemorrhoids

In a prospective study, 512 patients undergoing hemorrhoidal band ligation over a seven-year period were followed up to focus on complications. Thirteen patients (2.5 percent) were hospitalized: six with delayed massive rectal bleeding, three with urinary retention, pain, and fever (one developed perianal abscess), and three others with severe pain due to prolapsed thrombotic hemorrhoids (one developed difficulty in urination). One patient developed perianal abscess and perianal fistula two months after ligation. Twenty-four patients (4.6 percent) suffered from minor complications: 11 patients had painful thrombosed hemorrhoids; five experienced slippage of bands; three had mild bleeding; two developed band-related mucosal ulcer; one experienced each time, after two subsequent ligations, priapism lasting several hours; and difficulty in urination and tender induration above the dentate line occurred in two other patients. Rubber band ligation is, in effect, a miniature hemorrhoidectomy and has been considered, until recent reports of fatalities associated with this procedure, as an effective, safe, and efficient method of treating symptomatic second-degree and third-degree hemorrhoids. We conclude that the ability to handle complications that occur secondary to the rubber band ligation and, thereby, prevent sepsis and the low rate of major complications in our study justify reliance on this method of treating symptomatic hemorrhoids.

Endoscopic retrograde hemorrhoidal sclerotherapy using 23.4% saline: a preliminary report

Historically, injection sclerotherapy has had a prominent role in the treatment of symptomatic hemorrhoids. Concern over sclerosant-related morbidity and dissatisfaction with anoscopic injection techniques has limited the application of this modality in the United States. This study reports an initial evaluation of 23.4% saline, used as a nonallergenic sclerosant, in the flexible endoscopic treatment of symptomatic internal hemorrhoids. Initial results in 19 patients with symptomatic grade I, II, or III hemorrhoids suggest that the technique is very effective in relieving bleeding, and frequently alleviates prolapse as well. The technique has proven to be well tolerated and associated with high patient satisfaction and low complication rates, with no serious complications noted. This modality is eminently suited for single session examination and therapy of the patient undergoing endoscopic evaluation for lower gastrointestinal bleeding whose findings are limited to hemorrhoidal disease.

Anorectal pressure in patients with symptomatic hemorrhoids.

This study was carried out on 30 patients with symptomatic internal hemorrhoids and 20 normal controls. The anal sphincter pressure was studied before and after surgery. A significantly high anal pressure was found in all patients with symptomatic internal hemorrhoids, when compared with normal controls, and there was no relation between this increase and the degree of hemorrhoids. One week following surgery, this high pressure was reduced significantly and was not affected by the type of operation. Thus, this increase in resting anal pressure is due to an overactivity of the internal hemorrhoids, which is secondary to the presence of the hemorrhoidal mass.

Symptomatic internal hemorrhoids. What are your options?

Treatments for symptomatic internal hemorrhoids are many; in general, the method is designed to fit the severity of prolapse. Stool softeners work well for first- and second-degree hemorrhoids. Rubberband ligation, which is an easy and inexpensive office procedure, is used to treat second-degree hemorrhoids, and surgery is often necessary for third- and fourth-degree hemorrhoids. Other methods include sclerotherapy, dilation of the anus, sphincterotomy, and infrared photocoagulation.

Removal of hemorrhoids.

To the Editor:— In the presentation of our experience with the ligation treatment of internal hemorrhoids, we assumed it would be understood that a sigmoidoscopic and barium enema examination had been done before we elected to treat a patient with hemorrhoids. We specifically stated that the technique was applicable only to people with symptomatic internal hemorrhoids without other coexisting rectal conditions. In our experience, now running to over 150 patients, it has proven to be a most satisfactory method of treatment. The patients are pleased with the results and so are we. We still do an occasional hemorrhoidectomy, however.