Treatment of internal hemorrhoids: comparison of the efficacy and complications of endoscopic rubber band ligation and endoscopic sclerotherapy: a meta-analysis

Objective: Hemorrhoids are one of the most common benign anorectal diseases, and rubber band ligation is still the first-line nonsurgical treatment. Endoscopic treatment for hemorrhoidal diseases has become more popular in recent years. This paper aimed to comprehensively analyze and compare the therapeutic efficacy and prognosis of two common endoscopic treatments for hemorrhoidal diseases – ligation treatment and sclerotherapy – via a meta-analysis. Methods : The PubMed, Cochrane Library, Web of Science, Embase, CNKI, and other databases were searched to include all eligible randomized controlled trials (RCTs) comparing endoscopic rubber band ligation (ERBL) and endoscopic sclerotherapy (EIS) since the establishment of each database. The Cochrane Risk Assessment Tool was used to evaluate the quality of all included studies. Results : Based on the chosen inclusion and exclusion criteria, this study considered eight papers with a total of 824 cases. The combined effect sizes showed no significant difference in the overall efficacy of the two treatments. The subgroup analyses revealed that the prolapse relief/improvement was significantly higher with ERBL than with EIS. The occurrence of moderate/severe pain was significantly higher after ERBL than after EIS (OR = 4.18, 95% CI: 2.20–7.95, P < 0.0001). Conclusion : ERBL was more effective in the improvement of prolapse and is preferable if prolapse is the main symptom. Although the incidence of pain after ERBL is relatively high, analgesics can be applied to alleviate the pain. No significant differences were noted in terms of recurrence.