Qu Chun-Ying, Zhang Fei-Yu, Wang Wen, Gao Feng-Yu, Lin Wu-Lian, Zhang Hao, Chen Guang-Yu, Zhang Yi, Li Ming-Ming, Li Zheng-Hong, Cai Mei-Hong, Xu Lei-Ming, Shen Feng
Department of Gastroenterology & Endoscopy, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
Department of Gastroenterology, The 900 Hospital of the People's Liberation Army Joint Service Support Force, Fuzhou 350025, Fujian Province, China.
World J Gastroenterol. 2024 Jul 21;30(27):3326-3335. doi: 10.3748/wjg.v30.i27.3326.
Endoscopic rubber band ligation (ERBL) is a nonsurgical technique for the treatment of symptomatic internal hemorrhoids but is limited by recurrence and post-procedural pain.
To evaluate satisfaction, long-term recurrence, and post-procedural pain in managing internal hemorrhoids using a combination of polidocanol foam sclerotherapy and ERBL.
This was a prospective, multicenter, randomized study. A total of 195 consecutive patients diagnosed with grade II-III internal hemorrhoids were enrolled from four tertiary hospitals and randomly divided into a cap-assisted endoscopic polidocanol foam sclerobanding (EFSB) or an ERBL group. All patients were followed-up for 12 months. Symptom-based severity and post-procedural pain were assessed using a hemorrhoid severity score (HSS) and a visual analog scale (VAS). Continuous variables were reported as medians and interquartile range.
One hundred and ninety-five patients were enrolled, with 98 in the EFSB group. HSS was lower in the EFSB group than in the ERBL group at 8 weeks [4.0 (3.0-5.0) 5.0 (4.0-6.0), = 0.003] and 12-month [2.0 (1.0-3.0) 3.0 (2.0-3.0), < 0.001] of follow-up. The prolapse recurrence rate was lower in the EFSB group at 12 months (11.2% 21.6%, = 0.038). Multiple linear regression analysis demonstrated that EFSB treatment [B = -0.915, 95% confidence interval (CI): -1.301 to -0.530, = 0.001] and rubber band number (B = 0.843, 95%CI: 0.595-1.092, < 0.001) were negatively and independently associated with the VAS score 24 hours post-procedure. The median VAS was lower in the EFSB group than in the ERBL [2.0 (1.0-3.0) 3.0 (2.0-4.0), < 0.001].
Cap-assisted EFSB provided long-term satisfaction and effective relief from the recurrence of prolapse and pain 24 hours post-procedure.
内镜下橡皮圈套扎术（ERBL）是一种治疗有症状内痔的非手术技术，但受复发和术后疼痛限制。
评估聚多卡醇泡沫硬化疗法与ERBL联合治疗内痔的满意度、长期复发率及术后疼痛情况。
这是一项前瞻性、多中心、随机研究。从4家三级医院连续纳入195例诊断为Ⅱ-Ⅲ度内痔的患者，随机分为帽辅助内镜下聚多卡醇泡沫硬化套扎术（EFSB）组或ERBL组。所有患者随访12个月。使用痔严重程度评分（HSS）和视觉模拟量表（VAS）评估基于症状的严重程度和术后疼痛。连续变量以中位数和四分位数间距报告。
共纳入195例患者，EFSB组98例。随访8周时，EFSB组的HSS低于ERBL组[4.0（3.0 - 5.0）对5.0（4.0 - 6.0），P = 0.003]；随访12个月时亦如此[2.0（1.0 - 3.0）对3.0（2.0 - 3.0），P < 0.001]。EFSB组12个月时脱垂复发率较低（11.2%对21.6%，P = 0.038）。多元线性回归分析表明，EFSB治疗[B = -0.915，95%置信区间（CI）：-1.301至-0.530，P = 0.001]和橡皮圈数量（B = 0.843，95%CI：0.595 - 1.092，P < 0.001）与术后24小时VAS评分呈负相关且独立相关。EFSB组的VAS中位数低于ERBL组[2.0（1.0 - 3.0）对3.0（（2.0 - 4.0），P < 0.001]。
帽辅助EFSB提供了长期满意度，并有效缓解了术后24小时的脱垂复发和疼痛。
