Hemorrhoidal elastic band ligation during routine colonoscopy: A comparative study between flexible video endoscopy and rigid proctoscopy.

BACKGROUND: Among patients referred for colonoscopy to evaluate bowel bleeding, many present with hemorrhoidal disease-associated bleeding and prolapse. AIM: To compare endoscopic band ligation (EBL) with rigid proctoscope band ligation (RPBL) in patients referred for colonoscopy due to internal hemorrhoids. METHODS: This retrospective cohort study included 171 patients with previous anal bleeding and hemorrhoidal prolapse complaints who underwent routine colonoscopy who were referred for band ligation treatment. Seventy-five patients underwent EBL, and 96 underwent RPBL. Control of bleeding, prolapse recurrence, pain, tenesmus, overall satisfaction, and cost were analyzed. A log-binomial regression model was used to analyze and compare binary outcomes between the ligation types, which allowed for the direct estimation of relative risks. RESULTS: EBL achieved hemorrhoid symptom control in 92% of patients after a single session, compared with 63.5% for RPBL, which typically required three to four sessions (P < 0.01). Short-term prolapse was significantly lower with EBL (13.3%) than with RPBL (55.2%, P < 0.01), and long-term prolapse recurrence remained lower (8% vs 36.5%, P < 0.01). Short-term bleeding was also reduced with EBL (4% vs 19%, P < 0.01), while long-term bleeding control was comparable between groups (97.3% vs 92.7%). RPBL patients were more likely to report pain (relative risk = 1.29; 95% confidence interval: 1.08-1.54; P < 0.01). Overall satisfaction was markedly higher in the EBL group (86.7% "very satisfied") than in the RPBL group (24%, P < 0.01). CONCLUSION: EBL demonstrated superior control of hemorrhoidal symptoms, lower prolapse recurrence, and better short-term bleeding outcomes compared with RPBL. Long-term bleeding control and tenesmus rates were comparable; however, numerical trends favored EBL. Despite a higher per-session cost, the reduced number of sessions made overall expenses similar. EBL appears to be a more effective, efficient, and well-tolerated minimally invasive option for treating symptomatic internal hemorrhoids.