Comparative Evaluation Of The Efficacy And Safety Of Endoscopic Ligation Treatment And Endoscopic Injection Sclerotherapy Treatment For Internal Hemorrhoids

Objective:To comprehensive evaluate two main endoscopic treatment methods for internal hemorrhoids by comparing the efficacy and safety of endoscopic ligation treatment and endoscopic injection sclerotherapy treatment.Methods:According to inclusion and exclusion criterias,all patients who diagnosed as internal hemorrhoids and underwent endoscopic treatments in the First Affiliated Hospital of Nanchang University from January 1,2019 to December 30,2021 were selected.All patients were divided into endoscopic ligation treatment group or endoscopic injection sclerotherapy treatment group.The baseline data,postoperative efficacy,improvement in clinical symptoms,postoperative life quality,intraoperative/postoperative adverse reactions,and recurrence were compared between the two groups.Finally discuss and analyze the results.Results:1.The 123 patients who underwent endoscopic treatment were included in this study,they were cured(n=73,59.3%),improved(n=34,27.6%),ineffective(n=16,13.0%),and the postoperative effective rate was 86.9%.There were no intraoperative adverse events.There were some postoperative adverse events,including postoperative fever(n=6,4.8%),hematochezia(n=10,8.1%),uroschesis(n=2,1.6%),constipation(n=13,10.6%),perianal pain(n=27,22.0%).2.Comparison of baseline data between endoscopic ligation treatment group and endoscopic injection sclerotherapy treatment group:there were no significant differences in gender,age,operation duration,preoperative hemoglobin,preoperative bleeding score,preoperative Goligher grade,preoperative main symptoms,other concurrent endoscopic treatments,number of intraoperative ligation/sclerotherapy location,past history and personal history between the two groups(P>0.05).The hospital stays in the endoscopic ligation treatment group was longer than that in the another group(P<0.05),and the hospitalization expenses in the endoscopic ligation treatment group was significantly higher than that in the another group(P<0.001).3.The postoperative efficacy of the endoscopic ligation treatment group:cured(n=31,56.4%),improved(n=17,30.9%),ineffective(n=7,12.7%),and the effective rate was 87.3%.The endoscopic injection sclerotherapy treatment group:cured(n=42,61.8%),improved(n=17,25.0%),ineffective(n=9,13.2%),and the effective rate was 86.8%.There was no significant difference in the postoperative efficacy between the two groups(P>0.05).4.Postoperative bleeding score and postoperative Goligher grade were not significantly different between the two groups(P>0.05),and the improvement in symptoms of internal hemorrhoids were similar in the two groups.5.There were significant differences in the bleeding score and Goligher grade before and after endoscopic treatment(P<0.001).Endoscopic treatment could significantly alleviate the clinical symptoms of internal hemorrhoids.6.There were no significant differences in life quality score and time return to regular diet between the two groups(P>0.05).The median time return to regular diet was 7 days after the operation in the two groups.7.Compared with the endoscopic injection sclerotherapy treatment group,the endoscopic ligation treatment group was more likely to cause postoperative hematochezia and perianal pain(P<0.05),and there were no significant differences in other adverse reactions(P>0.05).8.The degree of postoperative perianal pain in endoscopic ligation treatment group was significantly higher than that in endoscopic injection sclerotherapy treatment group(P<0.05).9.Recurrence of 48 patients who were effective treated in the endoscopic ligation treatment group:postoperative recurrence(n=12,25.0%),the median recurrence time was 6 months after operation.Recurrence of 59 patients who were effectively treated in the endoscopic injection sclerotherapy group:postoperative recurrence(n=10,16.9%),and the median recurrence time was 5.5 months after operation.There were no significant differences in postoperative recurrence and median recurrence time between the two groups(P>0.05).10.Among the 107 patients with effective treatment,22 patients had occurred recurrence.Operation duration,preoperative Goligher grade and bleeding score are related risk factors for postoperative recurrence after endoscopic treatment,while preoperative Goligher grade and bleeding score are independent risk factors for postoperative recurrence after endoscopic treatment.Conclusion:1.Endoscopic treatment is an effective and safe way for internal hemorrhoids,and can effectively relieve the symptoms of internal hemorrhoids.2.The hospital stays of endoscopic ligation treatment was longer than that of endoscopic injection sclerotherapy treatment,and the hospitalization expenses of endoscopic ligation treatment were significantly higher than that of endoscopic injection sclerotherapy treatment.3.The treatment efficacy and the improvement in clinical symptoms of internal hemorrhoids were similar in endoscopic ligation treatment and endoscopic injection sclerotherapy treatment.4.Compared with endoscopic injection sclerotherapy treatment,endoscopic ligation treatment was more likely to cause postoperative hematochezia and perianal pain,and the degree of postoperative perianal pain in endoscopic ligation treatment was higher than that in endoscopic injection sclerotherapy treatment.5.Operation duration,preoperative Goligher grade and bleeding score are related risk factors for postoperative recurrence after endoscopic treatment,while preoperative Goligher grade and bleeding score are independent risk factors for postoperative recurrence after endoscopic treatment.