Office-based treatments for hemorrhoidal disease grades I-III ‒ Comparing rubber band ligation and polidocanol foam...

office-based treatments for hemorrhoidal disease (HD) are recommended when medical management fails. Both, rubber band ligation (RBL) and polidocanol foam sclerotherapy (PFS) can be used. However, few studies compare these treatments. This study aimed to compare the efficacy and safety of PFS versus RBL.

this retrospective cohort study analyzed patients with HD treated with RBL and/or PFS between January 2015 and April 2024. The patients were classified into two categories: standard treatment of up to four sessions (ST) or double standard treatment (DT) of up to eight sessions. The outcomes were clinical success (CS), relapse, relapse-free survival (RFS) and treatment failure (TF). Adverse events were registered.

in total, 441 patients were included, 290/441 (65.8 %) treated with RBL, 105/441 (23.8 %) with PFS and 46/441 (10.4 %) with both. After treatment, 289/395 patients (73.2 %) achieved CS, with 260/289 (90.0 %) needing ST and 29/289 (10.0 %) DT. Patients treated with RBL were significantly more effective in achieving CS (78.6 % vs 58.1 %, p < .001, phi = .205). Of the patients with CS, 61/289 (21.1 %) relapsed (75.4 % of RBL and 24.6 % of PFS, p = .544, phi = .033) with a median time to relapse of 15.5 (14.5) months (17.0 [15.0] of RBL vs 12.0 [7.0] of PFS, p = .008, r = .339). RFS did not differ between groups. A total of 49/395 (12.4 %) required surgery (13.8 % of RBL vs 8.6 % of PFS, p = .164, phi = .070). Goligher I/II and RBL were independent predictors of CS. A total of 49/1,223 (4 %) adverse events were reported, 41/49 (83.7 %) related to RBL and 8/49 (16.3 %) related to PFS (p = .003, phi = .086).

patients treated with RBL appeared more likely to achieve CS, while PFS showed a more favorable safety profile.