Abstract
OBJECTIVE: This study aimed to evaluate the comparative effectiveness, safety, and recurrence rates of endoscopic sclerotherapy (ES), endoscopic rubber band ligation (RBL), and combined ligation - sclerotherapy (CT) for grades I - III internal hemorrhoids. METHODS: A retrospective analysis was conducted on patients who underwent endoscopic minimally-invasive treatment for internal hemorrhoids at Wuhu First People's Hospital from January 2020 to December 2024. Patients were divided into ES, RBL, and CT groups. Safety was evaluated by recording post-procedural pain and adverse events. Efficacy was assessed within 3 months post-treatment, and recurrence was defined as symptom reappearance > 3 months post-treatment. Patient satisfaction was also recorded. RESULTS: A total of 253 patients were included (168 males, 85 females; mean age 46.2 ± 12.8 years), with 107 in the ES group, 122 in the RBL group, and 24 in the CT group. Hemorrhoid grade distribution was 68 cases (26.9%) of Grade I, 112 cases (44.2%) of Grade II, and 73 cases (28.9%) of Grade III. In terms of efficacy, for all grades combined, the efficacy rate was 90.6% (95/107) for ES, 92.6% (113/122) for RBL, and 95.8% (23/24) for CT. CT showed the highest efficacy, especially for grade III hemorrhoids (95.0% [19/20]). Regarding safety, ES had a lower proportion of severe pain (6.5% [7/107]). Adverse events had low rates (bleeding: 4.2-6.6%; fever: 2.8-4.2%) with no significant inter-group differences. Patient satisfaction rates were 84.1% (90/107) for ES, 82.0% (100/122) for RBL, and 83.3% (20/24) for CT, with no substantial variation. For recurrence rates, CT had the lowest rate (4.3% [1/23]), followed by RBL (9.7% [11/113]) and ES (11.6% [11/95]), particularly evident in higher-grade hemorrhoids. CONCLUSION: Endoscopic treatments, especially CT, are effective and relatively safe for grades I - III internal hemorrhoids. CT shows promise in terms of efficacy and recurrence prevention, especially for more severe cases.