Colonoscopic band ligation for internal hemorrhoids - A tertiary care experience

Background and objectives: Rubber band ligation (BL) is the most widely used technique for treatment of symptomatic internal haemorrhoids (IH) that are refractory to conservative treatment. The aim of this study is to assess the efficacy of colonoscopic BL as therapy for symptomatic IH. Methods: Patients seen at our center with symptomatic IH who underwent BL between January 2006 and December 2011 were included in this prospective study. The clinical and colonoscopic details were entered in uniform structured data forms. Results: Two hundred and eighteen consecutive patients with symptomatic IH were enrolled in the study. The presentations were rectal bleeding in 150 (69%) and prolapse in remaining 68 (31%) patients. Twenty-four patients (11%) had chronic liver disease (child B-C). Same operator treated all the patients. The severity of the IH was classified by using Goligher grading system. The mean age of patients was 48.3 + 15 years with range of 22 - 85 years. The mean follow up was 3months (range 1 month - 36 months). In 209 patients (96%) there was at least 1 grade reduction in hemorrhoids as well the symptoms were controlled. Two patients required surgery and another 7 patients required repeat session of banding. After banding session 32 (15%) patients had perianal pain and 13 (6%) had mild bleeding. Conclusions: Colonoscopic BL is a safe, and effective outpatient therapeutic procedure for symptomatic internal hemorrhoids. Furthermore, the BL is safe and effective in patients of coagulopathy associated with chronic liver disease