Endoscopic polidocanol foam sclerobanding for the treatment of grade II-III internal hemorrhoids: A prospective, multi-center, randomized study

Figure 1 Endoscopic transparent cap-assisted endoscopic foam sclerobanding for the treatment of internal hemorrhoids. A: An obvious red color sign of internal hemorrhoids was observed with the transparent cap (indicated by arrows); B: Submucosal foam polidocanol injection, the white foam, was prominently raised; C: Negative pressure remove and ligation of the hemorrhoids with a retroflexed position. The white ball (arrow) is the ligated mucosa after foam sclerotherapy injection.

Figure 2 Treatment and follow-up of a patient with grade III internal hemorrhoids. A: Internal hemorrhoids with prolapse; B and C: Endoscopic foam sclerobanding (EFSB); D: 12 months after EFSB without apparently prolapse; E: Formation of scars (arrow) in retroflexed; F: Formation of scars (arrow) in normal position.

Figure 3 Flowchart of patient inclusion, exclusion and intervention. During the study period, 217 patients with grade II or III internal hemorrhoids were enrolled. A total of 22 patients were excluded, 2 with ulcerative colitis (remission), 4 with malignant tumors, 1 with sicca syndrome, 3 over 60 years of age, 7 with colon polyps > 1 cm in diameter or at > 3 sites, and 5 who were lost to follow-up. The remaining patients were randomly assigned to endoscopic rubber band ligation (n = 97) or endoscopic foam sclerobanding (n = 98). EFSB: Endoscopic polidocanol foam sclerobanding; ERBL: Endoscopic rubber band ligation.

Figure 4 Box plots. A: Hemorrhoid severity score in the endoscopic rubber band ligation (ERBL) group and the endoscopic foam sclerobanding (EFSB) group according to follow-up time. Before procedure (T0), at 8 weeks (T4), and at 12 months (T5) post-procedure. Upper and lower whiskers indicate the 75^th percentile plus 1.5 interquartile range (IQR) and the 25^th percentile indicates minus 1.5 IQR. Outlier: A value greater than the 75^th percentile plus 1.5 IQR; B: Pain visual analogue scale score in the ERBL group and the EFSB group on follow-up at 24 hours (T1) and 1 week (T2) post-procedure. Upper and lower whiskers indicate the 75^th percentile plus 1.5 IQR and the 25^th percentile minus 1.5 IQR.