Department of General Surgery, McMaster University, Hamilton, ON, Canada.
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
Int J Colorectal Dis. 2023 May 3;38(1):112. doi: 10.1007/s00384-023-04394-w.
Symptomatic internal hemorrhoids affect up to 40% of people in Western society. Patients with grade I-III hemorrhoids, who fail lifestyle and medical management, may benefit from office-based procedures. As per the American Society of Colon and Rectum Surgeons (ASCRS), rubber band ligation (RBL) is the first-line office-based treatment. Polidocanol sclerotherapy is a relatively new approach for these patients. The aim of this systematic review is to compare the efficacy of RBL and polidocanol sclerotherapy with the treatment of symptomatic grade I-III internal hemorrhoids.
The systematic review was completed by searching MEDLINE, Embase, and CENTRAL databases from inception to August 2022 for prospective studies comparing RBL and polidocanol sclerotherapy or evaluating the efficacy of polidocanol sclerotherapy alone for adult (> 18 years) patients with grade I-III internal hemorrhoids. Treatments were evaluated for therapeutic success and post-procedure morbidity.
Of 155 citations obtained, 10 studies (3 comparative and 7 single-arm studies) and 4 abstracts (2 comparative and 2 single arm) were included in the study. The patients undergoing sclerotherapy had a 93% (151/163) therapeutic success rate compared to 75% (68/91) in the RBL group (OR 3.39, 95% CI 1.48-7.74, p < 0.01). The post-procedure morbidity was 8% (17/200) in the sclerotherapy group and 18% (23/128) in the RBL group (OR 0.53, 95% CI 0.15-1.82, p = 0.31).
This study highlights that polidocanol sclerotherapy may be associated with higher therapeutic success in patients with symptomatic grade I-III internal hemorrhoids. Further evaluations in the form of randomized trials are required to evaluate patient populations, which may benefit more from sclerotherapy.
在西方社会，多达 40%的人患有症状性内痔。对于 I-III 级内痔患者，经生活方式和药物治疗失败后，可能会从基于办公室的治疗中受益。根据美国结肠直肠外科学会（ASCRS）的建议，橡皮圈结扎（RBL）是基于办公室的一线治疗方法。聚多卡醇硬化疗法是这些患者的一种相对较新的治疗方法。本系统评价旨在比较 RBL 和聚多卡醇硬化疗法治疗症状性 I-III 级内痔的疗效。
本系统评价通过检索 MEDLINE、Embase 和 CENTRAL 数据库，从建库到 2022 年 8 月，收集比较 RBL 和聚多卡醇硬化疗法或评估聚多卡醇硬化疗法单独治疗成人（>18 岁）I-III 级内痔患者疗效的前瞻性研究。评估治疗的疗效和术后发病率。
在 155 篇引文中，纳入了 10 项研究（3 项比较研究和 7 项单臂研究）和 4 篇摘要（2 项比较研究和 2 项单臂研究）。硬化治疗组患者的治疗成功率为 93%（151/163），而 RBL 组为 75%（68/91）（OR 3.39，95%CI 1.48-7.74，p<0.01）。硬化治疗组的术后发病率为 8%（17/200），RBL 组为 18%（23/128）（OR 0.53，95%CI 0.15-1.82，p=0.31）。
本研究表明，聚多卡醇硬化疗法可能与治疗症状性 I-III 级内痔患者的疗效更高相关。需要进一步开展随机试验评估可能从硬化疗法中获益更多的患者人群。
