Rapid Communication
Copyright ©2007 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jan 28, 2007; 13(4): 585-587
Published online Jan 28, 2007. doi: 10.3748/wjg.v13.i4.585
Elastic band ligation of hemorrhoids: Flexible gastroscope or rigid proctoscope?
M Cazemier, RJF Felt-Bersma, MA Cuesta, CJJ Mulder
M Cazemier, RJF Felt-Bersma, CJJ Mulder, Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands
MA Cuesta, Department of Gastrointestinal Surgery, VU University Medical Center, Amsterdam, The Netherlands
Author contributions: All authors contributed equally to the work.
Correspondence to: M Cazemier, Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, VU Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands. marcel.cazemier@wanadoo.nl
Telephone: +31-204-440613 Fax: +31-204-440554
Received: October 31, 2006
Revised: November 4, 2006
Accepted: December 25, 2006
Published online: January 28, 2007
Abstract

AIM: To compare rigid proctoscope and flexible endoscope for elastic band ligation of internal hemorrhoids.

METHODS: Patients between 18 and 80 years old, with chronic complaints (blood loss, pain, itching or prolapse) of internal hemorrhoids of grade I-III, were randomized to elastic band ligation by rigid proctoscope or flexible endoscope (preloaded with 7 bands). Patients were re-treated every 6 wk until the cessation of complaints. Evaluation by three-dimensional anal endosonography was performed.

RESULTS: Forty-one patients were included (median age 52.0, range 27-79 years, 20 men). Nineteen patients were treated with a rigid proctoscope and twenty two with a flexible endoscope. Twenty-nine patients had grade I hemorrhoids, 9 patients had grade II hemorrhoids and 3 patients had grade III hemorrhoids. All patients needed a minimum of 1 treatment and a maximum of 3 treatments. A median of 4.0 bands was used in the rigid proctoscope group and a median of 6.0 bands was used in the flexible endoscope group (P < 0.05). Pain after ligation tended to be more frequent in patients treated with the flexible endoscope (first treatment: 3 vs 10 patients, P < 0.05). Three-dimensional endosonography showed no sphincter defects or alterations in submucosal thickness.

CONCLUSION: Both techniques are easy to perform, well tolerated and have a good and fast effect. It is easier to perform more ligations with the flexible endoscope. Additional advantages of the flexible scope are the maneuverability and photographic documentation. However, treatment with the flexible endoscope might be more painful and is more expensive.

Keywords: Hemorrhoids; Barron ligation; Rigid scope; Endoscope; Anal endosonography